I believe that executives often underestimate the basic requirements needed to change an organization. They under plan, under budget, and under sell the new idea, too. They don't expect resistance.

In the past 20 years, Diagnostic Related Groups were implemented, HIPAA is now a concern, HMOs came, and, to some degree, went away, as did managed care in general. Hospitals reduced beds and laid off staff, then created long-term care units only to close those units and convert them back to acute-care, as bed shortages developed. Continuous Quality Improvement, Total Quality Management, and six sigma were introduced – all with little apparent impact or longevity.

In 2006, are nurses happier with their roles? Has technology freed up time and reduced paperwork? Do patients see positive results from cost controls and quality improvement projects? No.

When I first became involved in large-scale change efforts, I thought that people resisted change because they didn't understand it or they disagreed with it. I learned the hard way that people resist change even when they agree with it. This attitude is magnified in organizations that have seen new programs and policies come and go like flavors of the month.

And physicians underestimate the value of their support. I once heard a physician comment on the building of a new replacement facility. He said, "Yes, building a new hospital and a new clinic on a new site is a very good idea. It's a once in a lifetime opportunity. We should make the new facility as efficient and patient-friendly as possible." Then he paused and said, "I don't think it will ever happen." This statement was devastating to staff morale.

Management and staff can learn from the research on death and dying – the ultimate change. People go through the same steps in dealing with organizational change:

Not changing is never a viable option. Even in nature, death starts where change stops.