Kotter’s Change Management Theory in Nursing Practice


To achieve long-term quality improvement, it is critical to creating an appropriate theoretical foundation for change implementation. In professional nursing, there is a great variety of theories that can be used as a basis for change initiatives. Kotter’s change management theory, also known as Kotter’s 8-Step Model of Change, can be utilized to assist in quality improvement projects in various settings, including interventional radiology. The present paper will seek to explain Kotter’s theory and its key components, as well as describe how it can be applied in clinical practice.

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Kotter’s change management theory can be described as a middle-range theory, as it is used to describe and predict the change process. This theory can also be tested empirically, which distinguishes it from grand theories. Kotter’s model is not specific to nursing and can be utilized in a variety of settings and organizations. According to Kotter’s theory, the change implementation process consists of 8 distinctive steps (Small et al., 2016):

  1. Create a sense of urgency;
  2. Form a guiding coalition;
  3. Create a vision;
  4. Communicate the vision;
  5. Empower employees to act on the vision;
  6. Create quick wins;
  7. Build on the change;
  8. Institutionalize the change.

The primary goal of the model is to help leaders implement the change by transforming organizational culture and motivating employees to contribute to quality improvement. By engaging employees in the process, Kotter’s theory can help to ensure acceptance of change, thus increasing the chances of success.


Kotter’s change management theory rests on several main assumptions. Firstly, the author assumes that the change process consists of multiple phases, each requiring different actions from the leadership and the management. This assumption is at the foundation of the theory, as it affects the structure of Kotter’s model. Secondly, the theory presumes that the success of a change depends on whether or not it is accepted by people in the organization (Rajan & Ganesan, 2017). The theory also accepts that employee empowerment and motivation have a direct impact on the success of change implementation.

Kotter’s approach to change involves transforming organizational culture, vision, and strategy while also enhancing employee motivation to ensure that the change is accepted. Hence, the final assumption made by the author is that organizational culture influences quality. Many of these assumptions were based on research, as there are studies that show a positive correlation between change acceptance, organizational culture, employee motivation, and the success of a change initiative.


The theory of change proposed by Kotter has four key characteristics. First of all, it represents change as a series of stages, depending on the actions that need to be taken. The theory is also oriented at leaders and the management, as it argues that change begins at the higher levels of the organization. Another essential characteristic of the model is that it is focused on motivation and strategic success. This feature enables leaders to fit the change into the company’s strategic goals, thus increasing the probability of success. Lastly, Kotter’s theory provides sufficient organizational support for the change process by engaging employees from various levels of the hierarchy in the implementation.

Key Concepts and Relationships

There are six key concepts involved in Kotter’s change management theory: urgency, motivation, vision, strategy, short-term wins, and organizational culture. All of these concepts are interrelated and have a positive effect on the change process. For instance, a sense of urgency, created in the first step of the change process, includes motivation, which, in turn, increases employees’ contribution to change implementation. Vision and strategy are also connected to organizational culture and motivation since they help to foster employee engagement and set clear goals for the company. Short-term wins, or quick wins, are created during the seventh stage of the change program. The importance of short-term wins is based on the fact that they create a feeling of success, which, in turn, provides empowerment and improves acceptance of the change. According to Rajan and Ganesan (2017), “it is essential for the leaders to show [employee] that change being implemented is beneficial with tangible and quick results for [employees] to visualize the larger picture” (p. 194). Therefore, the success of a change initiative relies on the relationships between the key concepts of Kotter’s theory.

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Examples of Application

The proposed change management theory has been applied in various areas of nursing practice to assist in quality improvement. For instance, Small et al. (2016) studied the use of the model for implementing bedside handoff. The study found that using Kotter’s change management theory helped to improve communication, adherence to quality standards, and nurse satisfaction during bedside handoff. Different research by Auguste (2013) examined the usefulness of Kotter’s model for adopting electronic medical records in orthopedic surgical practice. The results showed that the model-assisted in the implementation process and helped to improve organizational culture, thus supporting a digital transformation of the unit.


All in all, Kotter’s change management theory can be successfully applied to achieve quality improvement in nursing practice. The model helps to ensure the acceptance of change, which is among the key predictors of success. Thus, apart from reducing downtime in interventional radiology, Kotter’s theory would assist in improving the quality of care throughout the unit by enhancing organizational culture and employee motivation.


Auguste, J. (2013). Applying Kotter’s 8-step process for leading change to the digital transformation of an orthopedic surgical practice group in Toronto, Canada. Journal of Health and Medical Informatics, 4(3), 1-4.

Rajan, R., & Ganesan, R. (2017). A critical analysis of John P. Kotter’s change management framework. Asian Journal of Research in Business Economics and Management, 7(7), 181-203.

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.

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"Kotter’s Change Management Theory in Nursing Practice." StudyCorgi, 21 Mar. 2021, studycorgi.com/kotters-change-management-theory-in-nursing-practice/.

1. StudyCorgi. "Kotter’s Change Management Theory in Nursing Practice." March 21, 2021. https://studycorgi.com/kotters-change-management-theory-in-nursing-practice/.


StudyCorgi. "Kotter’s Change Management Theory in Nursing Practice." March 21, 2021. https://studycorgi.com/kotters-change-management-theory-in-nursing-practice/.


StudyCorgi. 2021. "Kotter’s Change Management Theory in Nursing Practice." March 21, 2021. https://studycorgi.com/kotters-change-management-theory-in-nursing-practice/.


StudyCorgi. (2021) 'Kotter’s Change Management Theory in Nursing Practice'. 21 March.

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