Change Management in Practice: Strategic Frameworks in Action

A Public Health Transformation Case Study

Introduction 

The development of the Public Health Accreditation Board (PHAB) described by Bender, Beitsch, and Kronstadt (2017) is an exemplary case of strategic change management and institutional sustainability. Through a multiyear collaborative effort among federal, state, and local public health leaders, the PHAB program aimed to elevate public health practice standards and promote performance accountability. This paper analyzes the PHAB case study using change models and organizational insights from Modules 1–3, including Beer, Eisenstat, and Spector’s “Critical Path” model (Module 1), Kotter’s Eight-Stage Change Framework (Module 3), and strategies for cultural change and workforce engagement (Module 2). 

Applying the Critical Path Model 

Beer, Eisenstat, and Spector’s “Critical Path” approach outlines six interlocking steps for organizational revitalization, emphasizing the importance of behavioral change rooted in context rather than merely changing attitudes. The PHAB process embodies this philosophy from inception. First, it mobilized commitment by conducting a “joint diagnosis” of national public health capacity gaps through structured dialogue with more than 1,000 stakeholders. This collaborative effort revealed a shared need for a national accreditation system to strengthen consistency, transparency, and credibility in public health services (Bender et al., 2017). 

Second, the PHAB initiative developed a shared vision of a quality improvement infrastructure anchored in performance standards. This vision was sustained through consensus-building activities that engaged diverse actors from local practitioners to national associations. In line with Step 3 of the Critical Path, PHAB fostered consensus by gradually building institutional competencies, such as leadership capacity and evaluative tools, to support system-wide adoption. 

Rather than imposing change top-down, PHAB used pilot programs to spread revitalization (Step 4) and monitored results iteratively. It then institutionalized these improvements (Step 5) by creating a formal nonprofit organization in 2007 to oversee the accreditation framework. Finally, PHAB built an internal learning loop to monitor and adjust strategies based on evaluator and participant feedback, aligning with Step 6 of the Critical Path model. 

Kotter’s Eight Stages of Change  

John Kotter’s Eight-Stage Model of Transformational Change provides a complementary lens to evaluate the PHAB program’s strategic trajectory. According to Kotter (1995), skipping stages compromises sustainable transformation. PHAB's timeline reflects the rigor of sequential change: 

• Establishing a Sense of Urgency – The need for public health transformation emerged after 9/11 and Hurricane Katrina exposed capacity gaps. Stakeholders recognized the urgent need for system-level accountability. 

• Creating the Guiding Coalition – PHAB’s early coalition included the CDC, RWJF, ASTHO, NACCHO, and academic institutions, an inclusive coalition critical for legitimacy. 

• Developing a Vision and Strategy – The vision was to build a national accreditation framework that promoted consistency, learning, and continuous improvement. 

• Communicating the Vision – Through national listening sessions, working groups, and pilot sites, the vision was communicated widely. 

• Empowering Broad-Based Action – PHAB allows local pilot sites to meet standards and test the accreditation system. This inclusion fostered legitimacy and reduced resistance. 

• Generating Short-Term Wins – Early pilot site successes served as proof of concept and created momentum for broader adoption. 

• Consolidating Gains and Producing More Change – As more agencies sought accreditation, the program refined its tools and expanded its infrastructure. 

• Anchoring New Approaches in the Culture – Today, PHAB accreditation is embedded in the identity of progressive health departments, and renewal cycles ensure lasting impact. 

Addressing Resistance and Cultural Change 

Resistance to change is a natural barrier in any transformation effort. PHAB’s approach echoes strategies discussed in Module 2. Rosabeth Moss Kanter’s list of ten reasons why people resist change—such as fear of competence loss, ripple effects, or past resentments can be seen in early stakeholder concerns about accreditation (e.g., being judged, losing funding, increased reporting). PHAB minimized resistance by co-creating standards, offering technical assistance, and framing accreditation as a developmental—not punitive—process. 

In terms of cultural alignment, Module 2 emphasized matching strategy to culture and focusing on a few critical behavior shifts. PHAB targeted specific behaviors such as implementing quality improvement systems, performance tracking, and stakeholder engagement. It respected the decentralized U.S. public health system, honored local autonomy, and allowed for customization while maintaining core standards, thereby avoiding cultural clashes. This is consistent with the idea that “digital (or systemic) change doesn't have to be disruptive,” but rather a series of intentional, trust-building steps. 

Additionally, PHAB recognized that workforce adaptation was key. Contrary to fears that health department staff might resist accreditation, many embraced it once they saw it as an opportunity for capacity-building and recognition. This reinforces Module 2's insight: the workforce is often more adaptable than leaders assume. 

Sustainability and Long-Term Impact 

Sustainability was not an afterthought in the PHAB model; it was embedded from the start. Through strategic funding from the CDC and the Robert Wood Johnson Foundation, PHAB secured both initial support and transition resources for long-term viability. Moreover, by collecting annual feedback and improving its tools and standards, PHAB institutionalized continuous learning. Its success can be traced back to the concepts outlined in the Critical Path model, particularly institutionalizing revitalization through structures and ongoing evaluation. 

In parallel, Kotter’s final stage anchoring new approaches in culture—is evident in how PHAB accreditation has become part of public health professional norms. As more agencies participate, peer pressure, reputational benefits, and inter-jurisdictional comparison further reinforce the system’s sustainability. 

Conclusion  

The PHAB case demonstrates how strategic change models can guide complex public transformations. Through early coalition-building, behavioral focus, and incremental wins, PHAB exemplifies both Beer et al.’s Critical Path and Kotter’s Eight-Stage Framework. By anticipating resistance and aligning change with professional values, the initiative ensured long-term cultural fit and workforce buy-in. As public health systems continue to face global threats, the PHAB model offers a replicable blueprint for managing change that is both strategic and sustainable. 

References 

Bender, K., Beitsch, L., & Kronstadt, J. (2017). Development of a national public health accreditation program: A case study in strategic change management and sustainability. Journal of Public Health Management and Practice, 23(3), 315–324. https://www.jstor.org/stable/48517064

Beer, M., Eisenstat, R. A., & Spector, B. (1990). Why change programs don’t produce change. Harvard Business Review, 68(6), 158–166.

Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59–67.

Kanter, R. M. (2012). Ten reasons people resist change. Harvard Business School Blog. Retrieved from https://hbr.org/