Transformational Leadership: Kotter's Model for Healthcare Change

This essay critically discusses the role of a transformational leader in facilitating a performance improvement strategy within the healthcare sector, specifically focusing on improving bedside handover practices. It highlights the importance of leadership in creating a flexible and adaptable workplace, emphasizing the necessity of using a change theory, such as Kotter's 8-step change model, to guide the change process. The essay explores how a transformational leader can motivate and prepare organizational members to adopt changes, improve communication, and ensure patient safety during clinical handover. It addresses the challenges and barriers in the change process, the impact of organizational culture, and the importance of benchmarking best practices. Furthermore, the essay provides strategies for motivating and engaging stakeholders and staff throughout the performance improvement journey, emphasizing the role of a transformational leader in changing individual behaviors and fostering a culture of continuous improvement to achieve long-term organizational goals.

Running Health: Transformational Leadership and Katter’s Change Model
Building organizational capacity in health care
Report
System04104
5/26/2019

Transformational Leadership and Katter’s Change Model
1
Introduction
A leader has always a great impact on the organizational performance. A leader plays
the role of a mentor, guide, role model, and instructor etc. and motivate other people in the
organization to achieve the goals or improve the performance up to the desired level.
However, it has been seen that the role of a leader in healthcare organization is so important
because the success of healthcare and patient safety depends on the proper coordination and
communication among the staffs and nurses (Botting, 2011). However, during the clinical
handover process, it has been seen that there is a huge miss-communication and lack in
coordination among the staff create a major problem related to patient safety. In such
circumstances, the role of a transformational leader will be so important to avoid these
barriers during the clinical handover process by bringing an organizational change. This
report has been prepared to understand the Kotter’s change model in the healthcare
organization and role of a transformational leader that how he/she can motivate and
encourage people towards the change and improving the performance in the organization.
This report also helps to understand the role of transformational leader in improving the
healthcare performance. In the second part of the report, the Kotter’s change model has been
discussed with every step and how organisation can bring the changes and ensure its success
in the healthcare organisation during the clinical handover process.
Transformational leader and his strengths to improve the
organizational performance
Improving the performance of organisational people may be the first propriety of a
leader. Improvement can be achieved by better clinical practices, changing routine practices
in the healthcare organization, or changing the organizational supports by bringing change in
the organizational culture. However, the role of a transformational leader is to motivate and
prepare the organisational people to adopt the changes in the organisation and focus on their
work improvement factors. A transformational leader never focuses on the exchanges
relationship as a transaction leader rather a transformational leader always makes a strong
relationship with their subordinates. A transformational leader helps other propel to engage
with one another and increase the morality in the people and leader as well. However, this
strength of the transformational leader may be required in facing the challenges during
clinical handover process where most of the nurses and staffs are facing such type of

Transformational Leadership and Katter’s Change Model
2
problems during the handover process (Langley & Denis, 2011). However, a transformational
leader always focuses on the objectives and goals of other people in the organisational rather
than looking for their own interest. These qualities and strength of a transformation leader not
only helps other people to improve their performance rather it also helps the people to
achieve their target within the specific or given time period with efficiency and effectiveness.
The role of transformational leader during the clinical handover process is so crucial as a
transformational leader can help the nurses to communicate properly and exchange the
information related to patient health and safety with full efficiency and effectiveness.
Transformation leader also known for transforming the individuals by changing their
culture, behaviour, or attitude that leads to change in organisational change and positive
improvement in the performance of employees. Transformational leaders help to individual
and organisation to focus on long term goals and arrange the activities in right direction. In a
healthcare organisation, a transformational leader can also play a role of supervisor or
monitoring the performance of employees. However, the transformational leaders always
focuses on new vision and articulate new goals for the organisational people that can help the
nurses and staff in the healthcare organisation improve their performance in the long term.
Transformational leaders are so charismatic person who always focuses motivating people
and boosting their confidence (Chaboyer, Johnson, Hardy, Gehrke, & Panuwatwanich, 2015).
These types of leaders can be counted in charismatic leaders who cannot only boost the
confidence of people rather enhance the belief of people that they can achieve anything.
Transformational leaders are also responsible for setting ethics and values in the organisation,
as they are responsible for setting accountable standards for the people in the healthcare
organisation. These all qualities and strength of a transformational leader may help the
organisation to improve the performance and provide better healthcare practices to the
people.
Clinical handover process and major challenges
The major challenge in clinical handover process is to ensure a better communication
among people because ineffective communication among the nurses and staffs is the major
contributor to the patient harm during the clinical handover process. It has been seen that
nurse generally do not provide accurate and proper information to the next nurse or staff who
will receive the responsibility of patient next. Clinical handover generally means transfer of
professional responsibility and accountability for some or all aspects of care of patient to the

Transformational Leadership and Katter’s Change Model
3
other person or group of people (Hawken, Lee-Wright & Walsh, 2012). It has been seen, in
the hospitals and care centres that when patient is shit from one ward to another ward, the
transfer if responsibility, information, and accountability are automatically placed to another
ward to another people. Apart from this, when the shift or duty period of nurses will be over,
the clinical handover process will always be taken place.
Need for change
The improper communication, poor coordination, poorly documentation of treatment
procedure and poor understanding words of people leads to some serious problems regarding
patient safety and health during the clinical change process. These are the essential reasons,
why a healthcare organisation needs change (Kaufman & McCaughan, 2013). However,
bringing change in the organisation not only improve the performance of organisational
people rather it also help to ensure the patient safety and care. Implementation of proper
change in the organization is not limited to culture, practices, or training rather bringing
change in the bedside handover practices is necessary. However, it is not possible to
implement the change with proper planning and practices.
Importance of Benchmarking in the performance improvement
Setting benchmark for improving the performance is necessary. A leader may help in
setting the benchmark which is feasible for the employees and staff to achieve. Apart from
this, the role of a transformational leader during the bedside handover process is crucial
because a transformational leader provides proper guidelines and coordination among the
healthcare employees and staff to achieve the set performance and provide a desired level of
patient care work. A transformational leader can provide various relevant ideas to and plan
for the organizational nurses or staff during the bedside handover process that helps to reduce
the mistakes in the organisation and ensure proper patient care and services (Source: Botting,
2011). Apart from this, poor technology and coordination among the different functions and
departments in the healthcare organisation also lead to various healthcare issues and problems
that required change management and its proper implementation in the organisation.

Transformational Leadership and Katter’s Change Model
4
Role of Transformational leader in bringing change in the
organisation
Apart from this, a transformation leader can approach the nurses and staff of the
healthcare organisation to perform their best and also provide a best care to the patient.
Irresponsible behaviour of nurses or exchanging inappropriate information may leads to
insecurity and unsafe environment for the patient. Apart from this, a transformational leader
is also responsible for changing or transforming the behaviour, nature, and culture of
individuals and organisation as whole. These strength of transformation leader helps to
implement the changes in the organisation and eliminate the resistance of people towards the
change. Although, it is human nature that people always resist changes but if a
transformational leader inspires and motivate the nurses or other staff in the organisation, the
change can be easily implemented in the organisation (Bamford‐Wade & Moss, 2010).
Barriers and Facilities in change process and role of a leader in managing
change
Adoption of change in the organisation is a real issue in change management process.
The nurses and staffs of the organisation never want to accept the change because it is human
nature of resisting change. Adoption of change in the organisation is a real issue in change
management process. The nurses and staffs of the organisation never want to accept the
change because it is human nature of resisting change. A transformational leader can change
the mentality of people and influence them to adopt the change in the organisation. However,
it is a problem for a leader that how can he manage the people during change process and
how to lead effectively during the change process. A transformational leader also helps in
change the mentality of people and motivates them to acquire necessary skills and knowledge
to adopt the change process in the organisation (Fealy, McNamara, Casey, O'connor,
Patton,Doyle, & Quinlan, 2015).
Kotter’s Change Model
Change is the key of development, growth, and success in nay organisation and it also
applies on the healthcare industry. The modern organisation wants to move from the
traditional healthcare approach to the patient centric healthcare model and it requires change
in various functions, system, and even in the technology used in the healthcare organisations
(Jeffs, Beswick, Acott, Simpson, Cardoso, Campbell, & Irwin, 2014). Even the change needs

Transformational Leadership and Katter’s Change Model
5
a transformation in people mentality, behaviour, thinking, and approach to work and
organisational performance. However, change in technology is healthcare and the new
researches and findings in biological science world also forces organisation to adopt the
change. The first phases is ‘creating a climate for Change’ in which first three steps covered,
in the second phases ‘engaging and enabling the whole organisation’ three more steps are
covered, and in the third phases ‘implementing and sustaining change’ John Kotter explained
the remaining two steps of change process. These three phases and eight steps of Kotter’s
model in healthcare industries and improving the performance of nurses during handover
process have been discussed after the organisation culture and resistant of people during
change process.
(Source: Botting, 2011)
Resistance of Change and Role of organisational culture
Change management in the healthcare set-up is not an easy task rather it requires a
sequential of change management steps and strong organisational culture. People generally
resist changes because of poor trust in the organisational system (Poh, Parasuram, &
Kannusamy, 2013). The approach of people in the organisation will not be positive if they do
not like the change. However, it has been seen that nurses do not fulfil their responsibility and
do not share the full information with the other nurse, which leads to serious patient harm,

Transformational Leadership and Katter’s Change Model
6
and in some circumstances it will leads to death of the patient as well. The poor working
culture and behaviour of nurses do not accept the changes in the organisation. Another reason
behind these things is improper coordination between nurses. These are the some of the major
reason that nurses resist the change in the organisation. Sometimes absence of a written
document or improper writing of treatment process or drugs, which is not understand by the
nurses can also leads to the miss happening during the clinical handover process (Orr &
Davenport, 2015).
Importance of motivating Nurses/Staffs for adopting change and role of
transformational leader
The transformational leader can help in bringing change by preparing them about the
change. The transformational leader may help the nurses to improve the communication and
coordination during the handover process (Hendricks, Cope, & Baum, 2015). The patient
safety and life is accompanied with the handover process and a little mistake can cause a
serious problem for the patient. The leader can monitor the handover process, guide nurses,
and staff how they can ensure that full and proper information has been transferred to the next
people who take the responsibility and accountability of patient. A leader is a person who can
influence the people and encourage them to do anything. Thus, improving the performance of
employees can be directed and monitored by a leader and a leader can also ensure that every
people are doing things in the right direction. If they are not performing the things in well-
prescribed manner, the organisation needs a change that can help to guide and change the
culture of people and move them towards the right direction (Delaney, 2018).
Phase-I
Create a sense of Urgency: Kotter’s change model starts with ‘create urgency’,
which means the healthcare organisation will identify the need of change during the clinical
handover process and support will be created according to the requirement. In the first step, a
transformational leader required to perform a convincing dialogue with the organisational
people like nurses, staff, practitioners, trainees, and interns about the change and convince
them about the importance of change that why change is necessary to improve their
performance during the clinical handover process (El-Masri & Saddik, 2012).
Build a guiding team: This is one of the important phases in the Kotter’s change
model where the leader can help the change management team to build a guiding team, which

Transformational Leadership and Katter’s Change Model
7
have all the ideas about the change and encourages all employees for adopting the change
during the change process. This team motivates and encourage the nurses for cooperating the
change and take constructive approach towards the change. The transformational leader can
avoid the coalition among the nurses or team members, who are working on different position
or in different group of work. The team members of the organisation also need to do open
communication with people (Jensen, Lippert, & Østergaard, 2013).
Create a Vision for change: The third step in Kotter’s model is create a ‘vision to
change’ which means a set and specific goal and objective may help the organisational people
to understand that what is the main objective of the organisation behind implementing
change. During the handover process, the major problem is related to communication and
thus changes should be done in order to improve communication among people. For example,
a proper technology used for information transfer may help in improving the communication
process. Apart from this, regular nurses and staff team meeting may help to improve the
coordination among them (Wood, Crouch, Rowland, & Pope, 2015).
Phase-II
Communicate the Vision: This is one of the important step and phase in which the
change management team will have to take acceptance from the employees and they need
support of nurses to implement the change. Here the role of transformational leader is so
important, as he can motivate and encourage people for accepting the change in right way and
in positive manner. The transformational leader can communicate with the nurses and ensure
them how this change process can improve their performance during the clinical handover
process and how communication among nurses will be improved. The leader can talk about
the new vision of the organisation with the nurses and should serious take their questions,
doubt, and anxieties about the change (Boker & Thompson, 2013). It is important for the
leader to transform the needs of nurses and make them agree upon the new vision of the
organisation with change strategy.
Empower action: This is the fifth stage in the Kotter’s change model, where the
leader and organisation should focus on empowering the actions by removing the obstacles
from the organisation. The leader of the organisational here can talk with the nurses and other
staff of the organisation and should tell them what is going to be done during the change
process. However, the leader can also identify those nurses or staff who resist the change in

Transformational Leadership and Katter’s Change Model
8
the organisation and encourage them for their support to empower the action in the
organisation (Sabet Sarvestani, Moattari, Nasrabadi, Momennasab, & Yektatalab, 2015).
Create short-term wins: It is well known that success is one of the great
motivational factors in the healthcare organisation. Nothing is more important than success
for motivating the employees and the short terms success and wins during the change process
motivates other nurses to implement the changes for improving their communication skills
and improve the coordination during the clinical handover process (Small, Gist, Souza,
Dalton, Magny-Normilus, & David, 2016). The transformational leader here can accelerate
thee growth of change by rewarding those employees whose contribution in the change
process was appreciable.
Phase-III
Implementing and Sustaining Change: The seventh step of the Kotter’s change model
is maintaining the momentum. It also includes identification of the options for early changes
that are possible in future. The leader should ensure that people would not be overwhelmed
after getting the early success. It is the responsibility of the leader to maintain the same
intensity of action and quality of care during the clinical handover process, which is required
in the early stage of change. Thus, in the seventh phase, the transformational leader should
ensure that people are focusing on consolidate improvements and for this it is necessary that
leader guide and motivates people that they are continuously looking for improvements
(Runnacles, Moult, & Lachman, 2013).
Make it stick: The last step of kotter’s change model focuses on making the change as a
part of the core of the organisation. The change process only be successful if the behaviour,
nature, and perception of nurses are matched with the changes vision of the organisation. For
this, issue organisation must revises and reviews the organisational culture on regular basis.
However, a leader can ensure that the behaviour of nurses and staff in the healthcare
organisation must matches the organisational goals in order to perform best in the
organisation and achieve the goal with efficient and effective manner (Moss, Mitchell,
Thomson, Piskor, Biles, & Casey, 2017).
The John Kotter’s recommended the organisational leader and people that when all the
eight steps have been followed by the organisation, the organisation needs to set a new vision
when recruiting and staffing new people or employees in the organisation. This helps the

Transformational Leadership and Katter’s Change Model
9
organisation and the leader to motivate new staff and nurses in the healthcare organisation
towards the new goals and objectives. However, people who positively and actively accept
the change process must be rewarded in the healthcare organisation because it helps to boost
the morale of other employees (VanVactor, 2012).
Conclusion
In conclusion, the major challenge in clinical handover process is to ensure a better
communication among people because ineffective communication among the nurses and
staffs is the major contributor to the patient harm during the clinical handover process. It has
been seen that nurse generally not provided accurate and proper information to the next nurse
or staff who will receive the responsibility of patient next. The roles of transformational
leader then help to these people to improve their communication during the clinical handover
process by adopting the Kotter’s change model. However, the leader also motivates and
creates a positive environment that helps the employees to accept the change process rather
resisting the change. However, the role of leader is not only motivating people rather also
improve the performance of the individual in order to meet the organisation long-term goals
and objectives.

Transformational Leadership and Katter’s Change Model
10
References
Bamford‐Wade, A. N. I. T. A., & Moss, C. (2010). Transformational leadership and shared
governance: an action study. Journal of nursing management, 18(7), 815-821.
Boker, J. R., & Thompson, M. (2013). Transforming patient care: Aligning interprofessional
education with clinical practice redesign. Transforming Patient Care: Aligning
Interprofessional Education, 113.
Botting, L. (2011). Transformational change in action. Nursing Management-UK, 17(9).
Chaboyer, W., Johnson, J., Hardy, L., Gehrke, T., & Panuwatwanich, K. (2015).
Transforming care strategies and nursing‐sensitive patient outcomes. Journal of
Advanced Nursing, 66(5), 1111-1119..
Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in
Australia. Collegian, 25(1), 119-123.
El-Masri, S., & Saddik, B. (2012). An emergency system to improve ambulance dispatching,
ambulance diversion and clinical handover communication—A proposed
model. Journal of medical systems, 36(6), 3917-3923.
Fealy, G. M., McNamara, M. S., Casey, M., O'connor, T., Patton, D., Doyle, L., & Quinlan,
C. (2015). Service impact of a national clinical leadership development programme:
findings from a qualitative study. Journal of nursing management, 23(3), 324-332.
Hawken, J., Lee-Wright, R., & Walsh, S. (2012). Creating an environment of shared
leadership. British Journal of Healthcare Management, 18(8), 426-424.
Hendricks, J., Cope, V., & Baum, G. (2015). Postgraduate nurses’ insights into the nursing
leadership role. Do they intuitively link the role to patient safety?. Journal of Nursing
Education and Practice, 5(9).
Jeffs, L., Beswick, S., Acott, A., Simpson, E., Cardoso, R., Campbell, H., & Irwin, T. (2014).
Patients' views on bedside nursing handover: creating a space to connect. Journal of
Nursing Care Quality, 29(2), 149-154.

Transformational Leadership and Katter’s Change Model
11
Jensen, S. M., Lippert, A., & Østergaard, D. (2013). Handover of patients: a topical review of
ambulance crew to emergency department handover. Acta Anaesthesiologica
Scandinavica, 57(8), 964-970.
Kaufman, G., & McCaughan, D. (2013). The effect of organisational culture on patient
safety. Nursing Standard (through 2013), 27(43), 50.
Langley, A., & Denis, J. L. (2011). Beyond evidence: the micropolitics of
improvement. BMJ quality & safety, 20(Suppl 1), i43-i46.
Moss, S., Mitchell, M., Thomson, A., Piskor, M., Biles, C., & Casey, V. (2017). The key to
improving clinical handover practices. Nursing management, 48(11), 45-51.
Neumeier, M. (2013). Using Kotter’s change management theory and innovation diffusion
theory in implementing an electronic medical record. Canadian Journal of Nursing
Informatics, 8(1), 1-9.
Orr, P., & Davenport, D. (2015). Embracing change. Nursing Clinics, 50(1), 1-18.
Poh, C. L., Parasuram, R., & Kannusamy, P. (2013). Nursing inter‐shift handover process in
mental health settings: a best practice implementation project. International Journal
of Evidence‐Based Healthcare, 11(1), 26-32.
Runnacles, J., Moult, B., & Lachman, P. (2013). Developing future clinical leaders for
quality improvement: experience from a London children's hospital. BMJ Qual
Saf, 22(11), 956-963.
Sabet Sarvestani, R., Moattari, M., Nasrabadi, A. N., Momennasab, M., & Yektatalab, S.
(2015). Challenges of nursing handover: a qualitative study. Clinical nursing
research, 24(3), 234-252.
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using
Kotter's change model for implementing bedside handoff: a quality improvement
project. Journal of nursing care quality, 31(4), 304-309.
VanVactor, J. D. (2012). Collaborative leadership model in the management of health
care. Journal of Business Research, 65(4), 555-561.

Transformational Leadership and Katter’s Change Model
12
Wood, K., Crouch, R., Rowland, E., & Pope, C. (2015). Clinical handovers between
prehospital and hospital staff: literature review. Emerg Med J, 32(7), 577-581.