According to Kotter's change model, which step is MOST critical to ensuring buy-in during an NPD-led system change?

According to Kotter's change model, which step is MOST critical to ensuring buy-in during an NPD-led system change?

• A. Communicating the change vision once to key leadership groups
• B. Forming a coalition of stakeholders across levels and departments
• C. Avoiding resistance by limiting early exposure to controversial changes
• D. Delegating implementation tasks to frontline staff without oversight

Answer: (B)

The most critical element is forming a guiding coalition that spans levels and departments. In Kotter’s approach, buy-in for a system-wide change grows when a diverse group of leaders and champions from across the organization collaborates to lead the effort. This coalition lends legitimacy, coordinates efforts across clinical units, education, informatics, administration, and other areas, and helps translate the vision into practical actions. When people from multiple roles share ownership, they model the desired changes, address concerns, allocate resources, and sustain momentum, making adoption more credible and widespread. Communicating the change vision to key leaders only is not enough because buy-in depends on broad understanding and engagement beyond a single group; ongoing, multi-channel communication helps ensure everyone understands the why, what, and how, and why it matters. Attempting to avoid resistance by limiting early exposure misses the chance to surface legitimate concerns and co-create solutions, which can erode trust and slow progress. Delegating implementation tasks to frontline staff without oversight removes essential governance and accountability, and without a coordinated approach, efforts may become disjointed and fail to align with safety and quality goals.

The most critical element is forming a guiding coalition that spans levels and departments. In Kotter’s approach, buy-in for a system-wide change grows when a diverse group of leaders and champions from across the organization collaborates to lead the effort. This coalition lends legitimacy, coordinates efforts across clinical units, education, informatics, administration, and other areas, and helps translate the vision into practical actions. When people from multiple roles share ownership, they model the desired changes, address concerns, allocate resources, and sustain momentum, making adoption more credible and widespread.

Communicating the change vision to key leaders only is not enough because buy-in depends on broad understanding and engagement beyond a single group; ongoing, multi-channel communication helps ensure everyone understands the why, what, and how, and why it matters. Attempting to avoid resistance by limiting early exposure misses the chance to surface legitimate concerns and co-create solutions, which can erode trust and slow progress. Delegating implementation tasks to frontline staff without oversight removes essential governance and accountability, and without a coordinated approach, efforts may become disjointed and fail to align with safety and quality goals.