The 5 Cs of Change

multi-colored lizard on branch

Learn the five components of leading change successfully.

By Jane K. Oeffner, PT, DPT, MBA

So now we’re going to talk about change management and leadership? After all we have been through the past two years? Wasn’t that scary enough?

COVID-19 took us all by such surprise that navigating it was about quick response tactics and logistics. There was no time to think about strategy and little time to think about change management and leadership. But we know that those who had been thoughtful about how they lead and manage change in the past fared best, likely because their systematic approach was hard-wired, and it helped them rise to the top during the most stressful time. Leaders hoping to emulate that success can look to five components of organizations that successfully navigate change: Culture, Communication, Courage, Conviction, and Compassion.


Culture plays a vital role in positive change management and is the springboard to the other Cs of change. Successful change begins with organizations whose culture is embedded in trust, where people feel safe to speak up, knowing they will not suffer any negative consequences.

Emulate this by letting staff speak their minds and express their stress, fear, and uncertainty. You became a “change agent,” communicating with purpose and compassion to facilitate successful personal transitions that enable your staff to engage, accept, and implement change. Remember that every problem, complaint, or issue they bring to you is an opportunity to build your relationship and open their mind to change. You want your staff to come to you or other designees versus their peers, where there is a risk of undermining the change to others.


You cannot communicate your change and vision strategy to your team frequently enough. During times of stress and fear, people’s capacity to absorb information is limited, so how you communicate is critical. Create a detailed communication plan as outlined in the Berkley Change Management Toolkit,1 which is a comprehensive, interactive resource.


As spoken by Teddy Roosevelt, “People don’t care how much you know until they know how much you care.” Just as communication is a vital component to successfully navigating change, compassion and the ability to understand what employees may be struggling with through a change is important to eventually gaining buy-in.

The Kubler-Ross change curve,2 which compares variability of morale and confidence of staff over time during a major change, provides insight to leaders and managers as to how and when to communicate and provide support. During the stages of shock and denial, reassurance of the positive effects of the change is needed. During the stages of frustration and depression, anger, blame, and apathy occur. Fixation on small issues and problems requires the leader to be prepared to respond to many situations with clarity and confidence. Once staff begin to engage with the new situation, ascending the curve to the experiment stage, communication to spark motivation and create alignment will move them to the decision stage and then integration stage, when they are immersed in the new reality and focusing on the future.2


You have to be sure in your heart the change is the best move for all and convey that through your actions and words. You can’t waver when you are challenged, and you will be challenged. Anticipate the questions you will surely receive so that you can answer with certainty.


Avoiding change and taking the path of least resistance will be smooth sailing for only so long. It takes courage to initiate change. Change is generally hard for people and, as a result, it can be demanding work to lead and manage change.


Change begets change. Once people experience a well-handled and successful change, they may become more open to and comfortable with change, begin to expect it, and even welcome it!

The only thing we are sure of is change. Thus, educating ourselves and our staff about change is time well spent. Talking about how to implement and embrace change at a staff meeting will likely go over like a lead balloon. Author and business and management thought leader John Kotter discusses the heart of change: “People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings.” The flow of see-feel-change is much more powerful than analysis-think-change. In Kotter and Rothgeber’s short book, Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions, they share a fable to elucidate the potential pitfalls of managing change and explain Kotter’s eight-stage process for creating major change.3 Another quick and inspiring read is New York Times bestseller Who Moved My Cheese? by Spencer Johnson, MD.4 Share these books with your staff, and discuss them, book-club style.

The best leaders and managers make an effort to really know their staff. From interpersonal, one-on-one interactions that break down barriers to using tools that provide more systematic data, leaders leverage data and information to lead and manage change. Who in your organization will initiate and champion change, helping others to see the possibilities and generate a feeling of faith? Who will be best at carrying out the details required to make the change seamless? And who will be late adaptor or even resistive to change and therefore need some extra attention? Tuning in to this information allows you to tailor your message and communication style for these various groups as well as create diverse, supportive teams that will best weather the storms of change. One assessment that addresses individuals’ readiness for change is Organizational Physics Management Style Indicator developed by Sisney.5

Organizational assessment tools assist leaders and managers in planning for change and making the business nimbler on a day-to-day basis by addressing barriers to change which include:

  • inwardly focused cultures
  • paralyzing bureaucracy
  • parochial politics
  • low level of trust
  • lack of teamwork
  • arrogant attitudes
  • lack of leadership
  • general human fear of the unknown6

The Organizational Change Readiness Assessment (OCRA), developed by Russell Consulting, is one such tool.7 The change leader completes the OCRA by gathering data from others regarding employees’ perceptions in 4 areas: 1) organizational support, 2) culture, 3) change environment, and 4) employee attitudes and behaviors.

Last, Kotter’s eight errors common to organizational change efforts generated his Eight-Stage Process of Creating Major Change.3,6

  1. Establish a Sense of Urgency
    Help others see the need for change by appealing to the senses of sight, touch, and feel, not just sharing data and business rationale, so as to overcome complacency, immobilization, self-protection, fear, anger, and pessimism.
  2. Create a Guiding Coalition to Lead the Change
    Comprise the coalition of people from all parts and levels of organization with the right mix of knowledge, credibility, stature, and management and leadership skills to ensure perspective and buy-in.
  3. Develop a Change and Vision Strategy
    In collaboration with the Guiding Coalition, make it clear, sensible, and uplifting.
  4. Communicate for Understanding and Buy-In
    Use every vehicle possible, especially technology, to repeatedly share the new vision and strategies always with a clean, confident message. Listen, address feelings, and be honest.
  5. Empower Broad-Based Action
    Remove barriers, particularly those that undermine the change vision. Encourage risk-taking and new ideas and actions.
  6. Generate Short-term Wins
    Celebrate victories along the way in a planned, incremental, visible, meaningful, and timely manner to nourish faith in and attract others to the change effort. Recognize and reenergize those working hard for change, make nay-sayers think again and build momentum.
  7. Consolidate Gains and Produce More Change
    Reinvigorate processes and people with new projects, themes and change agents while eliminating unnecessary, exhausting, and irrelevant work. This third wave of change requires some heavy lifting to reboot drained staff, and deal with any remaining silos and politics.
  8. Anchor the Change in Culture
    Articulate the link between new behaviors and operations and organizational success so new behaviors become strong enough to replace old traditions. Promote those who truly reflect and encourage the new norms, not who is next in line.


Mike Manzo, PT, MPT, founder and CEO of Atlantic Physical Therapy Center, knew it would not be easy to transition his compensation model, but that it would benefit the clinicians involved in his 24-clinic practice. “Shying away from change because it can be painful and you don’t want to be the ‘bad guy’ furthers no one and, in fact, can be your downfall,” said Manzo. He took all the right steps, involving high-level leaders, area directors, and clinic directors in the planning. He piloted the new model on his area and clinic directors to determine the pain points he would encounter so he could be prepared to address concerns and also to garner buy-in. A short-term win with this group paved the way for the rollout to the rest of the clinical staff, as they then served as role models and change agents. “Communication and being there are the only ways to help move people to acceptance,” Manzo said. “It’s natural that you will have people who pretend the change isn’t happening, hoping it won’t, and those who will be stuck in ‘this is how we used to do it.’ Your job as the leader is to listen to each person and try to understand the reason for their reaction, and then address that reason in a way to move them forward. You can’t do that hiding in your office. You have to be out there, in person, sharing information and addressing concerns. If you leave any blanks, your staff will fill in the story.” Manzo hit all five Cs of change—Culture, Communication, Courage, Conviction, and Compassion—for a successful outcome. 

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1UC Berkeley HR. Change Management Toolkit. Accessed October 14, 2021.

2Elisabeth-Kubler Ross Foundation. Kubler Ross Change Curve. Accessed October 10, 2021.

3Kotter J, Rathgeber H. Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions. New York, NY: St. Martin’s Press; 2006.

4Johnson S. Who Moved My Cheese? An amazing way to deal with change in your work and in your life. New York, NY: Putnum; 1998.

5Sisney L. Organizational Physics: The science of growing a business.

6Kotter J. Leading Change. Boston, MA: Harvard Business School Press; 1996.

7Russell Consulting, Inc. Change Readiness. Published November 10, 2017.

8Coelho P. The Archer. New York, NY: Alfred A. Knopf; 2020.

Jane Oeffner

Jane Oeffner, PT, DPT, MBA, a PPS and Impact editorial board member, has led large therapy departments through major change and is currently Director of Business Development for KEY Functional Assessments Network. She can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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