Article Text

Download PDFPDF
Kotter’s 8 stages of change: implementation of clinical screening protocols for assessing patients for COVID-19 – a review of an academic medical centre’s preparedness
  1. Shashank Ravi1,
  2. Sunny R Patel1,
  3. Sheneé K Laurence2,
  4. Stefanie S Sebok-Syer1,
  5. Laleh Gharahbaghian1
  1. 1 Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Emergency Services, Stanford Health Care, Stanford, California, USA
  1. Correspondence to Dr Shashank Ravi, Stanford University School of Medicine, Stanford, CA 94304, USA; sravi1{at}


Background COVID-19 screening protocols rapidly evolved as a result of changing Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) recommendations. These protocols led to operational improvements at one large academic medical centre using change management methods explained in Kotter’s 8-stage change model.

Methods We reviewed all iterations of clinical process maps for identifying, isolating and assessing COVID-19 infections in paediatric and adult populations within one emergency department (ED) from 28 February 2020 to 5 April 2020. We incorporated CDC and CDPH criteria for the various roles of healthcare workers in ED patient assessment.

Results Using Kotter’s 8-stage change model, we outlined the chronological evolution of basic screening criteria, as well as how these were reviewed, modified and implemented during the onset and through the time of greatest uncertainty of COVID-19 in the USA. Our results demonstrate a successful creation, and subsequent execution, of rapidly changing protocols across a large workforce.

Conclusion We effectively applied a business change management framework to the hospital management response during a pandemic; we share these experiences and challenges to inform and guide future operational decision making during times of rapid change.

  • communication
  • management
  • continuous improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All listed authors were contributors to this submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.