HLTH 5003 Module 3 Change Leadership Plan Example

Readiness First, Then Eight Steps: A Change Leadership Plan for Opening a County Health Department's Integrated Family Health Clinic

Student Name

American College of Education

HLTH5003: Leadership and Management in Public Health Organizations

Module 3 Assignment

Instructor Name

October 19, 2026

The Change and Its Stakes

The composite county health department discussed in the previous two modules intends to open an integrated family health clinic in nine months, combining its WIC, immunization and family planning services under one roof with shared scheduling and check-in. The first module argued that the change is adaptive as well as technical, and the second found three program cultures, each protecting a different value, along with uneven language access. This module turns that analysis into a plan.

The stakes are practical. Families who need all three services now make an average of 2.6 separate visits to receive them, and WIC certification appointments are missed at a rate of about one in five, often by the same families who fall behind on vaccinations. A merger that staff resist, or that opens with a confusing front desk, could make those numbers worse before they get better.

Readiness Before Steps

Change models tend to begin with action. Weiner (2009) argues that organizations should first understand their readiness, which he defines as members' shared resolve to implement a change, called change commitment, and their shared belief in their collective capability to do it, called change efficacy. Readiness depends on how much people value the change and how they judge the task demands, the resources available and the situation. When readiness is high, people are more likely to start, persist and cooperate.

A short anonymous survey of the three programs' 38 staff, using items on commitment and efficacy, showed different starting points. Immunization staff valued the change moderately and felt capable of it. WIC staff valued it for families but doubted they could keep their counseling time in a shared schedule, so their efficacy was low. Family planning staff showed the lowest commitment, driven by privacy concerns. The plan therefore cannot use one message for everyone: it must raise efficacy for WIC and address the value conflict for family planning before either group will engage.

The Model and Its Evidence

Kotter (2012) lays out eight stages in order. A leader first makes the need for change felt, then assembles a group with enough credibility to steer it, shapes a picture of the future and a route to it, and spreads that picture widely. Next come clearing away what stops people from acting, producing visible early successes, using that momentum to push further, and finally rooting the new ways in the culture so they outlast the project. Staff and board members grasp the sequence quickly, which is much of its appeal. Its scientific base is thinner than its popularity. Stouten et al. (2018), comparing widely used practitioner change models with scholarly research, found support for many of the steps these models share, such as careful diagnosis, readiness, coalition building, a clear vision and early wins, while noting that the models themselves had rarely been tested as wholes. The plan uses Kotter's stages as a structure and draws on the research for how to carry each one out.

The Plan, Stage by Stage

Urgency will come from families, not from the director. In month one, the design team will present three anonymized family journeys showing the visits, waits and missed services under the current system. The guiding coalition, formed the same month, includes the health director, the three program managers, two frontline staff from each program, the union steward and a parent from the WIC advisory group. It will draft the vision in its own words; the working version is one visit, every service a family needs, privacy protected.

Communication will run through monthly all-staff meetings, a running list of questions and answers, and walk-throughs of the renovated space. Empowerment means removing specific obstacles: finance will write a cost allocation plan so staff can help across programs without grant compliance problems, and cross-training will begin with WIC staff shadowing immunization intake and the reverse. The first short-term win is planned for month four: on Tuesdays, families can book all three services back to back through a shared schedule, before any walls move. Consolidation follows as the combined waiting area opens in month seven, with enclosed booths where family planning patients check in unseen and a separate quick line for families who need only a vaccine. The change is anchored in month nine and after by rewriting job descriptions, orientation materials and performance measures around the integrated model. Every stage is scheduled so that staff see a benefit to families before they are asked to give up anything they value.

Resistance and Loss

Resistance will be treated as information. Family planning's concern about privacy is a design requirement, not an attitude to overcome, and the private booths exist because of it. WIC's concern about counseling time will be tested in the Tuesday pilot, with appointment lengths protected and measured. Staff will also lose familiar routines and, for some, a distinct program identity. The coalition will mark those losses openly, for example by keeping each program's name on its counseling rooms, and managers will hold individual conversations with any staff member considering leaving. If readiness among WIC staff remains low after the pilot, the plan will pause the next stage and extend cross-training rather than push ahead.

Communication Across Three Audiences

The plan must reach three audiences with different questions, and a single announcement will not serve them all. Staff want to know what will happen to their jobs, schedules and programs; they will hear first, in person, from their own program manager, before anything is said publicly, and every staff question will be answered in writing within a week. The board of health and county commissioners want to know cost, risk and whether grant rules are being respected; the director will brief them at the start with the cost allocation plan and at each milestone with the measures. Families want to know what changes for them, where to go and whether their information stays private; signs, a one-page notice and the text-message reminder system will explain the new check-in in English, Spanish, Vietnamese and Haitian Creole two months before opening, and front-desk staff will be ready to walk families through it on the first days. Each message will come from the person each audience trusts most for that question.

Timeline and Measures

The plan runs nine months to opening and three months after. It will be judged on three sets of measures. For families: average visits needed to receive all three services, target from 2.6 to 1.3; missed WIC certification appointments, target from about 20% to 12%; and family ratings of privacy and respect by language. For readiness: the commitment and efficacy survey repeated at months four and eight, with a goal of moderate or higher in all three programs. For staff: resignations and unplanned absences across the three programs set against the year before, and the share of coalition recommendations adopted. The health director will report these measures to the board of health at months three, six, nine and twelve.

References

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Stouten, J., Rousseau, D. M., & De Cremer, D. (2018). Successful organizational change: Integrating the management practice and scholarly literatures. Academy of Management Annals, 12(2), 752-788. https://doi.org/10.5465/annals.2016.0095

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67