Leaders and Health Care Organizational Change: Art, Politics, and Process

Stewart Gabel, M.D., has a lot to teach us about organizational change. He understands the psychology of health care providers and the pressures affecting us. He clearly has firsthand experience with change processes—both successful and unsuccessful—in health care organizations. He understands the inevitable turbulence of the transitional phase between idea and successful implementation in which successful leadership spells the difference between success and failure. He also knows about individual and organizational resistances, even the unconscious resistance often experienced by the leaders of change, and he points out the tactics that can mitigate these resistances.

Leaders and Health Care Organizational Change begins with an introduction to the challenges of leadership and the leader's many responsibilities during change processes. Gabel then takes us through each phase of the process, from the initial conceptualization of a major initiative for change through enlisting cooperation, planning, dealing with the disruption of change, deciding to stay the course versus revising the road map for change, and, finally, the solidification of gains. At each phase, the focus is on the challenges facing the leader and on the work of leadership.

Gabel also understands how important it is to teach through cases rather than using a purely didactic approach. Each chapter contains a number of case examples that all have the ring of believability. The cases are by far the best feature of this book. Gabel seems to want to give us both a theoretical approach to change and a series of techniques that we can use in our own organizations.

The problem with this book is not in the content but, for this reader, in the delivery. Despite the case examples, the writing style is that of an unexciting discursive essay—factual and uninflected. The case studies run, without any editorial demarcation, into case analyses, thus losing some of the punch that they might otherwise have had. Each chapter reads like a sequence of commentaries on points important to the topic at hand, ending in a summary that straightforwardly recapitulates the points just elaborated.

It is in this dryness and in the author's failure to offer synthetic insights rather than simple chapter summaries that the book disappoints. Despite the richness of Gabel's case examples, he chose not to capture, communicate, or leverage the energy and intensity that surrounds change. Nor does he offer synthetic commentary, drawn from case analyses, that would constitute a truly unique contribution to the literature of change. Again, from my perspective, a book that might have been truly brilliant emerges as useful, but hardly captivating.

Despite the book's shortcomings, I would recommend it to leaders who are engaged in significant change processes. The points Gabel makes are solid, the cases are realistic, and the guidance offered is educated, accessible, and quite useful.

Dr. Lister is managing partner of Ki Associates, an organizational consulting firm in Portsmouth, New Hampshire, specializing in work with governing bodies and executive teams of health care organizations.