Abstract
Key learning points Understand three dominant strategies of change. Understand the managerial implications of the strategies. Know when to use the respective strategies. Introduction Change is a constant rather than an exception in today’s organization. This applies to both the private and the public sector, and emergency medicine (EM) is no exception. From an external perspective, forces in the external environment can consist of changes in technology, social trends, political or legal decisions, environmental or ethical changes. Internal forces for change can emanate from many specific parts of an organization not functioning efficiently or effectively, with the parts of an organization being vision, strategy, structure, culture, human relations management (HRM), and systems. Alternatively, another internal force for change could be a misalignment between the parts of an organization, meaning the individual parts are working fine independently but the parts are not aligned. EM in particular is experiencing numerous pressures promoting change. These include restructurings in which the focus is on whether facilities should be centralized or decentralized, the implementation of new protocols or work practices, and in addition trying to change the internal culture such that EM is an accepted discipline. For most managers, the ability to lead change remains an elusive challenge. Thus, the first question is, why is change so difficult?