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The Improvement of Depression Management


The present paper summarizes the context analysis that was prepared for a change project aimed at the improvement of depression management. In particular, the project will seek to provide a health center with efficient, evidence-based guidelines on the use of psychotherapy and pharmacotherapy with patients with mild depression. The paper will describe the system, including its mission, values, culture, and interrelationships with other systems, and will apply Kotter’s change model to the proposed change and its settings.

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Description of System

The system of interest is the New Horizons Community Mental Health Center located in Miami, FL, which has been serving the Miami-Dade County since 1974. Currently, about 5000 patients of all ages and backgrounds can receive mental health and substance abuse care from the 180 staff members of the Center.

Mission, Vision, and Values

The mission of the system is to provide high-quality, comprehensive services to its community, and the vision is to establish an accessible healthcare system. The key values include high-quality care, inclusivity, innovation, and empowerment. The communication mechanisms for the mission, vision, and values include meetings and various forms of handouts.

Interrelationships of Systems

The system includes service-related subsystems (for example, substance abuse care) and administration. The project will need to ensure communication and collaboration between the two. The Center also belongs to the greater systems of the community and federal agencies, both of which determine the Center’s activities and vision as it responds to their needs and demands. The project takes this fact into account and is in line with the needs of the community.

System Culture

For the project, it is important that the values of high quality and innovation are a part of the organizational culture. Also, the culture is healthy (from the perspective of conflict management and stakeholder empowerment), which also promotes change (Davis, Wehbe-Janek, Subacius, Pinto, & Nathens, 2015; Fernandez, 2015). The Center may not take great risks, but the culture is apparently beneficial for changes.

Application of Model

Kotter’s model involves eight key steps, and the proposed project will use them to guide the process of change in multiple fields, including healthcare (Anders & Cassidy, 2014; Pollack & Pollack, 2014; Small et al., 2016). The first stage is supposed to demonstrate that the current status quo needs to be changed. For the proposed project, it is important that depression is a significant and relatively prevalent concern (Center for Behavioral Health Statistics and Quality, 2016, p. 3055; Olfson, Blanco, & Marcus, 2016). Furthermore, depression management encounters multiple problems, including insufficient knowledge of the effectiveness of antidepressants and psychotherapy for mild depression (Olfson et al., 2016; Reid et al., 2014; Spence, 2013; Straten, Hill, Richards, & Cuijpers, 2015). Consequently, providers lack direct and evidence-based guidelines, and this issue is acknowledged by the Center’s stakeholders. Thus, a sense of urgency is present.

The second stage requires the creation of the coalition, which was already performed. The members (the Director of the Outpatient Clinic, the Psychiatric Medical Director, a psychiatrist, and a nurse) were chosen for their credibility, expertise, and leadership abilities; also, two of them are in a position of power. All the members know each other, and their relationships are trusting and respectful; they pursue the common goal of high-quality care.

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The third step requires the development of the vision for the project, which has been created to emphasize the autonomy and collaboration of the care providers of the Center in their work on the development and adoption of the new guidelines and the contribution of evidence to the discussion on the topic. The connection of the vision to that of the organization makes it meaningful and motivational. The goals can be achieved, and the vision is feasible and desirable due to the above-described sense of urgency.

The Center is equipped with multiple mechanisms (meetings, leading by example, and so on) for communicating the vision, which is the fourth stage of the model. The fifth stage requires reviewing the possible obstacles. The analysis suggests that there are some issues related to change resistance and financial constraints that will be mitigated through careful budgeting and change management (Hanrahan et al., 2015).

The sixth stage requires the demonstration of short-term wins, which will be done through the communication mechanisms mentioned in stage four. The wins will be consolidated during stage seven through active communication and due to the destruction of barriers. Finally, the eighth stage requires “institutionalizing” the change (Anders & Cassidy, 2014), which will be facilitated by the organizational culture and communication.


The anticipated costs are minimal: no profit losses will occur, and it is possible to avoid printing costs with the help of technology. However, if the coalition and administration state that it is feasible to allocate more funds to the project, participants will be compensated, and additional communication mechanisms will be obtained.


The analysis demonstrates that the project needs to take into account the multiple specifics of the Center, including its interrelationships with other systems and culture. Kotter’s model provides a framework that can assist in managing the subsystems while institutionalizing the change. Currently, the first three steps of the model are completed, and the rest will be carried out in accordance with the results of the analysis.


Anders, C., & Cassidy, A. (2014). Effective organizational change in healthcare: Exploring the contribution of empowered users and workers. International Journal of Healthcare Management, 7(2), 132-151. Web.

Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 national survey on drug use and health: Detailed tables. Web.

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Davis, M., Wehbe-Janek, H., Subacius, H., Pinto, R., & Nathens, A. (2015). The trauma center organizational culture survey: Development and conduction. Journal of Surgical Research, 193(1), 7-14. Web.

Fernandez, C. (2015). The elusive “holy grail” of organizational culture and the power of like. Journal of Public Health Management and Practice, 21(4), 406-409. Web.

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J.,… Williamson, A. (2015). Sacred cow gone to pasture: A systematic evaluation and integration of evidence-based practice. Worldviews on Evidence-Based Nursing, 12(1), 3-11. Web.

Olfson, M., Blanco, C., & Marcus, S. (2016). Treatment of adult depression in the united states. JAMA Internal Medicine, 176(10), 1482. Web.

Pollack, J., & Pollack, R. (2014). Using Kotter’s eight stage process to manage an organisational change program: Presentation and practice. Systemic Practice and Action Research, 28(1), 51-66. Web.

Reid, I., Cameron, I., & MacGillivray, S. (2014). Depression: Current approaches to assessment and treatment. Prescriber, 25(12), 16-20. Web.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotterʼs change model for implementing bedside handoff. Journal of Nursing Care Quality, 31(4), 304-309. Web.

Spence, D. (2013). Are antidepressants overprescribed? Yes. BMJ, 346, f191-f191. Web.

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Straten, A., Hill, J., Richards, D. A., & Cuijpers, P. (2015). Stepped care treatment delivery for depression: A systematic review and meta-analysis. Psychological Medicine, 45(2), 231-246. Web.

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