Organizational change is notoriously difficult. In healthcare, change is even harder than in most industries. Clinical and administrative staff often view their work as a vocation as much as a profession. They are historically suspicious of senior administrators and resistant to strategic agendas.[1] That makes it sound even more interesting. What adventure isn’t somewhat perilous?

Leading change is worth the risk when the vision is clear, the strategy is well planned and executed; using an approach that is easily translated at the operational level. This article draws from the wisdom of those who’ve successfully done this, and supporting studies that show us how to create the conditions for the most successful path forward.

Start by Establishing a Growth Mindset

A growth mindset is defined as both the belief that skills and abilities can be improved, and that developing your skills and abilities is the purpose of the work you do. That means that the act of improving one’s capability is an essential focal point and an important part of the purpose for any work done. It’s distinguished from a fixed mindset here.

Research showed that “the extent that a leader espouses a growth mindset, employees perceived him or her as being more just, consistent with feedback, unbiased and willing to listen to employee input; these perceptions, in turn, were directly related to greater organizational commitment” and overall performance.[2]

A culture that fosters a growth mindset, then, is a culture in which all employees are seen as possessing potential, are encouraged to develop, and are acknowledged and rewarded for improvement.[3]

The advantages of cultivating an organizational growth mindset are:

47% of staff were likelier to say that their colleagues are trustworthy.

34% were more likely to feel a strong sense of ownership and commitment to the future of the company.

65% were more likely to say that the company supports risk taking and is supportive even after failure.

49% were likelier to say that the company fosters innovation and creativity.

How Do We Instill and Promote a Growth Mindset?

Teach from the Top: As you know, people learn from the behavior and communication they witness from the top of their organization. The message that helps is, “Be the best at getting better.” As leaders, we can focus on our teammates’ improvements over time, to communicate that it’s the process of getting better that moves the needle.

Praise the Process: When praise is given, it should emphasize whenever possible, the process that led to success.[4] For example, it helps to compliment hard work, persistence, use of good strategies, determination or attention to detail.

Incentivize Improvement: Make it clear that incentives and evaluation are motivated by a ‘get better’ orientation instead of a ‘be good’ orientation; meaning it’s more helpful to focus on an individual’s capacity to grow, versus relative ratings or rankings between colleagues. Put the emphasis on long term mastery over ability to tap into your team’s internal motivation to learn and grow. The research shows that this has a strong relationship to improved performance.

Bootstrap the Brain: Teaching people about neural plasticity increases the growth mindset. If you tell your team that with hard work they can change how smart they are, it will shift the way they processes errors. They’ll tend to use the feedback from errors to improve themselves for later performance, versus thinking they’re bad at something and giving up. The research showed that this increased satisfaction, engagement and performance at work.

In Practice, Take Three Approaches:

1. Guidance: Communicate your expectations for performance in very clear terms and use constructive feedback weekly, regarding performance outcomes. During your weekly check in, provide specific feedback for how to improve, with an emphasis on the process of ‘getting better’ versus ‘being good.’ For example, “I see that you’re working on improving the accuracy of your documentation. I noticed that you’ve gotten better at describing the way your patients are reaching their objectives in about 65% of your caseload. Consider documenting during the session, so that you’re able to capture even more detail in your daily notes as you continue to improve the accuracy of your documentation.”

2. Facilitation: Help your team to analyze and explore ways to solve problems and enhance their performance. For example, a team meeting could provide opportunities to role-play a short therapy session, so that others can ask questions and problem solve together. Create opportunities for your team to learn how to learn by challenging them to come up with multiple solutions to any problem. Show them how, then incentivize the best problem solvers with a reward.

3. Inspiration: Challenge people to realize and develop their potential by showing them that the learning process is the point, and mistakes are just opportunities to improve. When we communicate that we care as much about their long term capacity to advance as a professional, we show them that we value them, not just the work they do. “I’d like to see you own the Abilities Care program and teach it to your colleagues, because I think you would be a great resource for everyone in that regard.”

The advantage according to Travis Bradberry is that, “people with a growth mindset believe that they can improve with effort. They outperform those with a fixed mindset, even when they have a lower IQ, because they embrace challenges, treating them as opportunities to learn something new.”

The opportunities to learn new approaches to effective leadership will remain continuous in our work and in our lives. By establishing a growth mindset for yourself as a leader, you’ll model the humility, flexibility and willingness to learn that will surely be a positive contagion. With the ability to guide, facilitate and inspire others, engendering the long-term value of ‘getting better together’ the door is more likely to swing wide open for greater success during organizational change.


  • It’s really easy to talk about a growth mindset, but let’s take a closer look to better understand the difference. The good news is that one can shift their mindset simply with the awareness that they can shift, and thinking it through. Both people with a fixed and a growth mindset are concerned with performing well and excelling.

People in a fixed mindset believe you either are or aren’t good at something, based on your inherent nature, because it’s just who you are. “She’s a natural born athlete.” Or, “I’m just no good at sports.”

In a fixed mindset, you stick with what you know to keep up your confidence.

In a fixed mindset, you want to hide your flaws so you’re not judged or labeled a failure.

In a fixed mindset, you look inside yourself to find your true passion and purpose, as if this is a hidden inherent thing.

In a fixed mindset, failures define you.

In a fixed mindset, you believe if you’re romantically compatible with someone, you should share all of each other’s views, and everything should just come naturally.

In a fixed mindset, it’s all about the outcome. If you fail, you think all effort was wasted.

The fixed mindset believes trouble is devastating. If you believe, “You’re either naturally great or will never be great,” then when you have any trouble, your mind thinks, “See? You’ll never be great at this. Give up now.”

This sounds simple, but it’s surprisingly deep. The fixed mindset is the most common and the most harmful, so it’s worth understanding and considering how it’s affecting you.

People in a growth mindset believe anyone can be good at anything, because your abilities are entirely due to your actions.

In a growth mindset, you believe “Anyone can be good at anything. Skill comes only from practice."

The growth mindset believes trouble is just important feedback in the learning process. “This was hard, but I’ll learn more, keep practicing and see if I get better at this.”

In a growth mindset, your flaws are just a TO-DO list of things to improve.

In a growth mindset, you keep up your confidence by always pushing into the unfamiliar, to make sure you’re always learning.

In a growth mindset, you commit to mastering valuable skills regardless of mood, knowing passion and purpose come from doing great work, which comes from expertise and experience.

In a growth mindset, failures are temporary setbacks.

In a growth mindset, you believe a lasting relationship comes from effort and working through inevitable differences.

In a growth mindset, it’s all about the process, so the outcome hardly matters.

Rigorous preparation is essential. It goes without saying that organizational change can destabilize a person, a team and an organization. Here are three approaches that I recommend, to create a smoother path forward:

1. Build your team now, before the change is implemented. Teams that routinely operate with less trust may be more negatively impacted by further destabilization. Take the time to ensure that your team’s foundation is verifiably stable. In practice, this means that vulnerability-based trust is well established, conflicts are occurring in service of your common goal during meetings, accountability levels are high and definitively clear, and commitments are consistently and transparently kept. As a leader, you should be able to report your team’s results with fairly reliable progressive upticks toward your objectives. These capabilities will enable you and your team to take the challenges of the change process on with a much greater likelihood for success.

2. Find out what benefits matter to your employees by asking and listening. Do this by appointing especially dedicated employees to champion the change, and gather the information. For example, identify a therapist or nurse whose strength is to offer benevolent operational oversight. Then, introduce and communicate a combination of your employees perceived benefits. For example, offer the reassurance that “while we’ll be undertaking new processes or modes of service delivery, you will have all the support you need from your existing social network to be successful.”

3. Respect employees’ social relationships when designing structural changes! Identify and use existing social networks when designing future organizational structures, and to communicate your change efforts. Employees find strength and support from each other, which is especially critical during time of stress. Breaking these social bonds may increase resistance, and possibly invite sabotage.

Next, Anticipate Resistance

There have been many publications that address the cause of employee resistance during organizational change. One thing is clear: it will happen. Regardless of the cause, we can be proactive in reducing resistance while increasing the probability for success in the long term. Here’s how to prepare for less resistance:

1. Create emotional safety. It all boils down to safety. People want to know that they will still have a job, and that their friends at work will still be there during the change process. The perceived threat of the change is softened, knowing that the job security and emotional safety will remain in place.

2. Communicate clearly. Disseminate information about the reasons and process for change in transparent, clear and consistent terms. Communicating clearly creates a level of continuity that helps diminish the experience of perceived threat. Provide information early and often during the process, and ensure mutual understanding by actively listening to the concerns raised. Show your employees in very clear terms that you hear them, with actions that are congruent with their requests.

3. Get everyone involved. Actively involving everyone in the change process also tends to reduce fear and increase positive feelings. Empowering people to champion the change by owning operational areas about which they are passionate is critical to maintain a high level of participation. Allow people to use their strengths to facilitate the change in a specific operational area by listening. Participation amplifies success and reduces resistance.

4. Reinforce your team’s self-esteem. Studies showed that when employees perceived themselves to be competent and valuable to their organization, the concept of Organizational Based Self Esteem (OBSE) kicked in. OBSE had greater impact on one’s response than the perceived benefits.[1]

Finally, remember the obvious – change is challenging. Lean into the discomfort of the change process, and allow people to air their concerns. Resistance is an opportunity for us to expand our capacity to meet people where they are, and model the behaviors we wish to see by example. Showing your commitment to the process, while validating your employees and remaining transparent about your own experience of the challenges, will provide everyone with greater access to the strength, humility and resilience required to sustain the change successfully.

[1] (Packard, 2015)