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What leaders can do to help others cope with change

Leader of a team on cards (NI/Dreamstime)Last year I was one of three pharmacists selected to undertake the inaugural NHS clinical leadership fellowship programme. If you had asked me what I thought leadership meant before the programme, I would have said that I regarded a leader as being the captain of a ship: someone who has a vision and a crew to implement that vision. Indeed, this is what many textbooks would lead you to believe.

I have since learnt that being a leader is more complex than this and that a major part of leadership is being able to support people through change. Key lessons for leaders to learn are to understand the emotions that people go through when faced with change and to make sure the changes are being communicated in the right way, at the right time and to the right people.

Managing change

NHS organisations often focus strongly on restructuring systems and procedures, moving existing staff into new roles but neglecting to support them through the process.

How people respond emotionally to change has been widely researched. Kübler-Ross hypothesised that people go through a sequence of emotions, akin to the signs of grieving, when faced with major life changes. In order, these are:1

  • Shock
  • Anger
  • Denial
  • Self-doubt
  • Apathy or depression
  • Acknowledgement and resolve
  • Reflection and taking stock
  • Acceptance, setting new goals and integration

One model of change (known as “managing transitions”), which is derived from the works of Kübler-Ross, proposes that there are three distinct phases of a reaction to change: endings; the neutral zone; and new beginnings.2
As a leader, you can help people go through major changes to their working life by recognising which phase they are in and responding to their needs during this time.


When changes to a service or structure are planned, identify those who will be affected by the changes and what, if anything, they are set to lose.
Make an effort to understand what impact the loss might have on people’s roles and how important this is to them. Do not be surprised if people over-react and show signs of grieving. Acknowledge any losses openly and sensitively, and provide information updates regularly.

The neutral zone

The neutral zone is when anxiety levels rise, motivation levels fall, people become disoriented and teamwork falters. Try to protect staff from unrelated and unexpected changes. Make sure any policies and procedures are adequate in light of the changes taking place so that everyone involved knows what they should be doing. Do not be discouraged if it seems like progress is not being made — it can take time for people to adapt to change.

New beginnings

Leaders must communicate the need for change and clarify what it is intended to achieve. Be honest and specific and try not to use clichés (like ‘generating efficiencies’). Involve staff in the planning and value their input.
New beginnings come with feelings of realisation of the loss of the old ways together with relief, excitement and hope for the change.  Common communication pitfalls are discussed in the Box.

Bretwalda/DreamstimeFor change to be successful, it needs to be communicated effectively to all those involved; yet this is something many leaders do poorly. When a major change is expected, here are some examples of approaches to avoid when communicating a change to staff:2

Delaying announcements

You risk losing their trust and they could feel bitter towards you later. Provide regular updates from the start and be as open and honest as you can.

Excluding staff from the early stages of planning

Although there is a risk that people will be unduly frightened or resentful before a final decision has been made, involving staff in the plans from the start can help them feel more involved in the change and give them the opportunity to provide feedback.

Assuming that those you have delegated to manage the change are on board

A common failing of senior leaders is that they do not realise that key management staff are likely to be in transition themselves and may need to be supported accordingly.



1    Kübler-Ross, E. On death and dying. New York: Routledge; 1969.
2    The Welsh NHS Confederation. Review: Managing Transitions. (accessed 31 July 2013).

Aamer Safdar is principal pharmacist lead for education and development at Guy’s and St Thomas’ NHS Foundation Trust.


Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11125103

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