Digital transformation in healthcare is accelerating. From telemedicine and AI-driven diagnostics to electronic health records and mobile health apps, hospitals are rapidly adopting new technologies. This trend has only intensified in recent years, propelled by global initiatives and urgent needs. For example, the World Health Organization launched a Global Strategy on Digital Health 2020–2025, underscoring that digital health must become integral to health systems worldwide. The stakes are high: done right, digital innovations can improve patient outcomes, efficiency, and even provider satisfaction. Done poorly, however, they can disrupt care delivery or waste resources, destabilizing an already fragile system. In other words, the promise of digital health comes with a warning—technology alone isn’t a silver bullet. It requires human readiness and effective change management to realize its full value.

The Change Readiness Problem in Hospitals

Many healthcare organizations are not fully prepared for the waves of change that digital transformation brings. A 2021 study of hospitals in five European countries revealed a sobering insight: over half of hospital leaders do not use any formal change management framework when implementing innovations. Instead, most rely on ad-hoc approaches or intuition. Those who do use structured methods tend to gravitate to a few well-known models – with Kotter’s 8-Step model being the most common – but even these are applied inconsistently across different hospitals.

Survey data from five European countries reveals that over half of hospitals do not use any formal change management framework. Among those that do, Kotter’s 8-step model is the most common approach, while other models like McKinsey 7S, Lewin’s 3-step, or Prosci’s ADKAR are less frequently used. This lack of systematic methodology highlights a widespread challenge: many hospitals approach digital change without structured guidance, relying instead on ad-hoc or intuitive methods.

Why aren’t hospitals adopting change frameworks? According to the same study, some managers cite “personal obstacles” or a sense of impracticality in applying formal change management (in other words, they feel it’s too cumbersome or not suited to their situation). As a result, even though leaders recognize that changes should be managed systematically, they often fall back on improvisation. This lack of a systemic approach means critical elements can slip through the cracks. For instance, in many cases fundamental steps like setting clear success criteria, anticipating obstacles, or planning how to handle resistance are neglected.

Resistance is a pervasive issue. Nearly one-third of hospital managers admitted they have no standard strategy to manage staff resistance to new initiatives. Frontline healthcare staff – doctors, nurses, technicians – are famously hard-pressed for time and operate under high stress; if a new digital tool or process is imposed without understanding their needs and concerns, pushback is almost guaranteed. Unfortunately, healthcare settings are known to be resistant to change and have a lot on the line when implementations falter. A failed rollout of a new electronic health record system or telemedicine platform, for example, can disrupt clinical workflows and erode trust in future projects.

It’s telling that the study found IT and digital innovation projects to be the most “contentious” changes in hospitals, cited by 86% of respondents as particularly challenging. Digital transformation isn’t like a simple policy tweak; it often requires deep shifts in daily routines and core processes. If hospitals proceed with low change readiness, lacking staff buy-in, training, and a supportive culture, the risk is that these promising innovations underperform or even backfire, wasting the investment and failing to improve care. In short, the human side of change is the linchpin of digital transformation success.

Kotter’s 8-Step Model: Structure with Limitations

One of the best-known change management approaches in both business and healthcare is Kotter’s 8-Step model. John Kotter’s framework, introduced in the 1990s, outlines a series of steps for leading change: from creating a sense of urgency and building a guiding coalition, through communicating a vision and securing quick wins, to anchoring the change in the organizational culture. Hospitals have often turned to Kotter’s model because it provides a clear, structured roadmap that is relatively easy for employees to understand. In fact, Kotter’s core concepts (involving a coalition of stakeholders and communicating the vision) have been applied successfully in healthcare settings to improve outcomes, ranging from implementing new clinical protocols to increasing treatment effectiveness. The model’s appeal lies in its intuitive sequence and its focus on leadership-driven change, which can highlight potential problem areas early (e.g. identifying if certain processes or teams are “not ready” for the change).

However, Kotter’s approach has notable limitations, especially in complex, people-centric environments like hospitals. First, it’s fundamentally a top-down model; that is, change is driven by leaders and cascades down in a linear fashion. In healthcare, this can be problematic. Frontline staff may feel that change is something being “done to them” by management, which can foster frustration or disengagement. Kotter’s model does encourage communication and seeking buy-in, but it does not delve deeply into the human psychology of change at an individual level. The steps serve as high-level directives; there’s less guidance on how to manage the nuanced emotional and behavioral barriers that cause employees to resist change.

Another limitation is that Kotter’s 8 steps imply a finite project – a change happens, is rolled out, and then completed (“anchored” in culture). In reality, digital transformation is an ongoing journey. Hospitals face continuous waves of updates and new tools; treating change as a one-off event can lead to change fatigue or regression once leadership’s attention shifts. Critics note that Kotter’s model fails to account for the continuous nature of change in modern organizations. Without mechanisms for ongoing reinforcement or adaptation, there’s a risk that once the initial push is over, people slip back into old habits. In short, Kotter provides an excellent starting framework and is great for raising urgency and orchestrating big-picture change, but it may not fully engage the people on the ground or sustain long-term change in a dynamic hospital setting.

A People-Focused Alternative: Prosci’s ADKAR Methodology

Given these challenges, many experts advocate complementing or rethinking the approach to change in healthcare. One people-centered model that has gained traction is Prosci’s ADKAR methodology. ADKAR is an acronym for the five outcomes an individual needs to achieve for a change to be successful: Awareness, Desire, Knowledge, Ability, and Reinforcement. Unlike Kotter’s organizational 8-step recipe, ADKAR starts at the individual level – the idea that organizations change one person at a time, and if those people aren’t on board, the change will ultimately stall.

The ADKAR change management model focuses on five key milestones in an individual’s change journey: Awareness, Desire, Knowledge, Ability, and Reinforcement. By ensuring people understand why a change is needed, want to participate, know how to change, can implement the new skills, and continue to reinforce the change, ADKAR addresses many common failure points in digital transformations. It prompts a shift from passive compliance to active participation, meaning change isn’t something done to employees, but rather achieved with their conscious engagement.

Each element of ADKAR directly tackles a typical stumbling block in healthcare change initiatives:

• Awareness – People need to understand why the change is happening. In a hospital, that might mean communicating the patient-care benefits or regulatory requirements driving a new technology. Lack of awareness breeds rumors, fear, and misinformation. ADKAR ensures a clear why is established upfront, reducing uncertainty and speculation.
• Desire – Knowing why isn’t enough; staff must also want the change. This stage focuses on building motivation and addressing the personal WIIFM (“What’s in it for me?”). In practice, that could involve engaging nurses and physicians early, listening to their concerns, and finding champions among them who advocate the benefits. By fostering genuine desire (not just compliance), ADKAR helps convert resistance into support, making stakeholders active participants rather than reluctant observers.
• Knowledge – This is the training and education phase. If a hospital is installing a new electronic health record system, knowledge means providing effective training on how to use it, as well as informing staff about new workflows or protocols. A common reason digital projects falter is that end-users don’t feel competent with the new tools. ADKAR puts a spotlight on knowledge transfer – ensuring everyone has the information and skills needed to adopt the innovation.
• Ability – Even with training, there’s often a gap between theory and practice. Ability is about turning knowledge into action – giving people the time, hands-on practice, and support to actually change their behaviors. In healthcare, this might involve a phased rollout where staff can gradually build confidence using a new system with mentorship or support resources available. By securing ability, ADKAR addresses the “execution” risk – it’s not enough that staff know the change; they must be able to do it proficiently in their daily work.
• Reinforcement – Lastly, ADKAR stresses the importance of sustaining the change. Humans are creatures of habit; under stress, there’s a tendency to revert to old ways. Reinforcement might include celebrating successes, collecting feedback, providing continued coaching, or integrating the new practices into performance evaluations. This stage is crucial for making change stick. Especially in the fast-paced hospital environment, without reinforcement, initial enthusiasm can fade and new systems might be underutilized or circumvented. ADKAR’s focus on reinforcement ensures the change is solidified and the organization doesn’t slip back once the initial project phase is over.

In essence, ADKAR builds change readiness at the grassroots level. It ensures that each person affected by a digital transformation is brought along on the journey. This people-first focus can be a game-changer in healthcare, where broad top-down directives often falter if physicians or nurses on the floor aren’t convinced or prepared. By using ADKAR, hospitals can directly address the root causes of change failure – from employee resistance to lack of training – in a structured way. Notably, one industry commentary pointed out that the ADKAR model is ideal “if you want to ensure your employees are on board with the change”. Instead of treating people as cogs in a machine, ADKAR treats them as the engine of change.

Actionable Strategies for Building Change Readiness

For novice healthcare leaders, the concept of structured change management might seem abstract. So, how can you practically build change readiness in your hospital or department? Below are five actionable takeaways, inspired by research and real-world successes, to foster a change-ready culture:

1. Define and Communicate a Clear Vision – Always start with the “why.” Before rolling out a new digital tool or process, articulate a compelling vision of what it will achieve – better patient care, less paperwork, faster service, etc. Ensure this vision is widely communicated and understood at all levels. When people see a clear purpose and positive outcome, they’re more likely to get on board. Don’t assume everyone knows why the change matters; take the time to share stories or data that highlight the need and urgency for the transformation.
2. Engage Stakeholders Early and Often – Change is a team sport. Identify all the groups affected – doctors, nurses, administrative staff, IT, even patients – and involve them from the outset. Early engagement of all stakeholders not only surfaces concerns (so you can address them proactively) but also creates a sense of ownership. For example, form a multidisciplinary change committee or include end-users in pilot testing. When people feel heard and part of the process, their desire to support the change grows.
3. Build Knowledge and Ability with Support – Don’t skimp on training. Equip your staff with the knowledge and tools they need to succeed in the new way of working. This means comprehensive training, easy-to-access reference materials, and support systems (like a help desk or “super user” experts on each shift). Allocate time for people to practice new skills (e.g., simulations for a new electronic record system) to build their ability to perform effectively. Remember that in healthcare, people are busy and often stressed – so make training practical, concise, and relevant to their day-to-day scenarios.
4. Establish Clear Structure and Local Adaptation – Implement changes in a step-by-step approach with feedback loops. Break large digital projects into phases or pilot programs. Set precisely defined rules and roles for the change initiative: Who is responsible for what? What is the timeline? How will decisions be made? At the same time, be flexible and adapt to the local context and culture of your organization. A solution that works in one hospital may need tweaking in another. Encourage feedback at each stage and be willing to adjust your approach. This structured yet flexible strategy prevents chaos while respecting that each unit or team might have unique needs.
5. Address Resistance and Reinforce Progress – Anticipate pushback and plan for persistence. Even with all the above steps, some resistance is natural. Develop a strategy to manage resistance – for instance, by identifying influential skeptics and working with them individually, or by providing forums where staff can air concerns and get honest answers. Demonstrate quick wins early on (e.g., share a story of a patient who benefited from the new telehealth service) to show the change is working and worth the effort. Importantly, reinforce the change continuously. Celebrate milestones, recognize staff who adapt and contribute, and integrate the new practices into standard operating procedures. By keeping the focus on the change even after “go-live,” you signal that this is the new normal and keep everyone aligned.

These actions echo the findings of Hospodková et al.’s study, which emphasized factors like communication, stakeholder engagement, clear rules, local adaptation, and feedback as keys to sustainable change. They are simple in concept, but require commitment and consistency from leadership. As a new healthcare leader, making these practices habit will cultivate a more change-ready team over time.

Conclusion: Unlocking Digital Transformation’s Value Through People

Digital transformation is often talked about in terms of cutting-edge technologies and innovative platforms. But as we’ve seen, the true linchpin is people. Hospitals that invest in people-focused change management – that take the time to build awareness, desire, knowledge, ability, and reinforcement among their staff – are the ones that unlock the full value of those digital tools. In contrast, health organizations that neglect change readiness risk seeing their expensive innovations underutilized or resisted, yielding poor returns and frustration.

The opportunity is clear. Healthcare is at a crossroads, with unprecedented technological advances on one hand and pressing challenges (like workforce burnout and patient expectations) on the other. Embracing a people-centric change approach such as ADKAR doesn’t slow down innovation – it accelerates it by ensuring each innovation actually works in practice and delivers benefits. For novice healthcare leaders, developing these change management skills and mindsets early in your career will pay dividends. By seeing technology projects not just as IT deployments but as human endeavors, you will foster a culture that is adaptable, resilient, and primed for continuous improvement.

In the end, digital transformation in healthcare is not just a tech journey – it’s a change journey. And when you guide your people through change with empathy, structure, and engagement, you turn uncertainty into excitement. Hospitals that leverage this people-powered approach will not only keep up with the pace of innovation; they will set the pace, delivering better care and outcomes in the process. The future of healthcare belongs to those who are ready for it – and readiness is something you can build, starting now.

Sources:

1. Hospodková, P., et al. (2021). Change Management and Digital Innovations in Hospitals of Five European Countries. Healthcare (Basel), 9(11): 1508.
2. Prosci. ADKAR vs Kotter: Which Change Model Should You Choose? (2022)
3. Giva (Ron Avignone). The 3 Most Effective Organizational Change Management Models in Healthcare Practices. (May 10, 2021).