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Understanding Change by Dr. Gary Tithecott

Understanding Change

In reflecting this weekend on some personal, as well as a number of school, regional and national, health care challenges I am facing and involved with, I realized that change is a staple in the diet of everyday life.

While the US election and the issues and outcomes arising from it symbolize, for many, improvements through change (or a desire to reverse/freeze change), it is clear in our School and country that this goes beyond election cycles. Change has become a way we approach all we do.

I found two quotations that frame the need to embrace and better understand change:

Our School is in the process of change. While our documents and outcomes cite change as a Schulich School of Medicine & Dentistry constant (given the adherence by our Dean to supporting strategic planning as a visionary process to continually innovate patient care and curriculum), I am struck that, for many, there remain threads of what was highlighted in Drucker’s and Senge’s quotes

We all accept change as an act that will happen. The challenge is timing, and who will lead and support that change.

Change disrupts our comfortable norms and requires work. Change offers new opportunities, but can also result in a perceived loss.

I have broken down change into four issues:

  1. Change is a vision or goal: For some entities and individuals, not embracing change as a key part of your vision has proven fatal. The culture that is fostered by resisting change is one of perceived comfort and short term success. Soon a competitor overtakes you – either with better drive or new innovative processes – and you 'perish'. We see this in professionals who resist moving to new approaches to patient care, and miss the opportunity to better utilize funding, evidence and resources to drive for patients and families within the determinants that impact their health, stronger outcomes and satisfaction. Resisting change in the long term catches up with you.

  2. Change is a process: This is the toughest part. To change requires hard work. In my practice, every day, I tell patients and families that improving health is hard work, takes diligence, support, resource, understanding, rewards and a drive to succeed.

  3. Change is the same: John P. Kotter has coined in his famous work Leading Change the stages necessary to drive change. He cites leadership as the key success factor in leading organizations (and individuals) through the now accepted processes of: Establishing Urgency; Creating the Guiding Coalition; Developing a Vision and Strategy; Communicating the Change; Empowering Broad Based Action; Generating Short-Term Wins; Consolidating Gains and Producing More Change; and Anchoring new Approaches in the Culture. We as a School are embarking on a process of moving our educational platforms forward. Following these steps will be foundational to success and you will see, for some, these actions are already in place.

  4. Change is an outcome: Goals are foundational, processes deliver, outcomes are where we are held accountable to demonstrating value and improvement. Change is a key part of continual quality improvement – a process we as a school embrace and practise. However, the change we deliver must be for better outcomes that align with our vision. The outcome is the 'prize' we all have to keep our eye on during the process.

As a health professional and as a person, your life will be full of change – some for the better and, unfortunately, some experiences may be negative or cause regression. I urge you to understand each change that impacts you as an opportunity be an advocate and participant – make a difference and help make change for the better.

Where the change seems disruptive and not in keeping with what you want or expect, ask more questions, research and dig deeper. This may be the best idea you will ever see, packaged or processed in a way that needs you and your team’s attention. This may be the door you and your team are invited in that will define your career or patient care.

However, when the change is negatively disruptive and, in fact, likely to cause harm, push back and offer a different more positive vision for the perceived need. People wanting change have highlighted a problem. Your alternative may swing the negative to a positive.

I thank all who are at this early stage supporting our Dean’s vision for our educational pillars from Undergraduate to Postgraduate to Continuing Medical Education moving to competency-based outcomes. Each individual and team support – whether by town hall attendance, committee participation, written/verbal suggestions, and shared models and offers of collaboration – help our cause.

The goal from the strategic plan of our School to “Become a destination of choice for exceptional education and learning” will require each of us to step up in our own way and contribute within our individual level of competence and interest to move this process of change forward.

I trust that what we are embarking on will deliver the vision of Western University to "Raise our Expectations, Lead in Learning, Reach Beyond Our Campus and Take Charge of Our Destiny".

So throughout your career and life – in our School and beyond – I trust you will make understanding and harnessing change part of what you do to improve and succeed.

We value your participation and support in our educational program innovations.

Step up, support, contribute and make a difference. You will be glad you did.


Dr. Gary Tithecott



1. Quotes on Change. Leadership Now, 2016.
2. Drucker, Peter Ferdinand. Management Challenges for the 21st Century. Routledge, 2007.
3. Kotter, John P. Leading Change. Harvard Business Review Press, 2012.
4. Optimizing Life-long Health, Strategic Plan, 2011-2021. Schulich School of Medicine & Dentistry, 2011.
5. Achieving Excellence on the World Stage. Western University, 2014.