By: Allison McCarthy, MBA | amccarthy@barlowmccarthy.com
One of the frameworks I often use in coaching conversations is the Prosci ADKAR model, which focuses on the individual journey through change: Awareness, Desire, Knowledge, Ability, and Reinforcement.
What I find most valuable about ADKAR is how clearly it reveals where change efforts tend to stall. Often, organizations try to move quickly into implementation, but the earlier stages of awareness and desire haven’t been fully established.
In my coaching work with healthcare leaders, this dynamic shows up frequently.
When Leaders Themselves Are on the Learning Curve
A physician leader is working to become more comfortable with operational and financial reporting systems. For many physician leaders, these systems represent a significant learning curve. They are not always part of their natural training or experience. In this case, we focused first on building awareness and familiarity. Rather than trying to master everything at once, the leader began speaking with other physician leaders who use these tools regularly.
She asked questions such as:
- What reports do you review most often?
- What insights do you look for in the data?
- How do you translate those insights for other physicians in the group?
These conversations helped transform the systems from something intimidating into something more practical and approachable. But the key insight was this: until she developed her own awareness and desire to learn the systems, gaining knowledge and ability would continue to feel overwhelming.
Building Awareness Before Implementation
Another client is currently retooling their physician relations program. On the surface, the work appears straightforward: hire additional field representatives and expand outreach.
But effective physician relations programs require a more strategic foundation. Before hiring, organizations need to analyze referral data and market dynamics to determine:
- How many field representatives are truly needed
- How territories should be assigned
- What performance expectations should look like
Leadership’s initial instinct was to simply hire staff and send them into the field. Introducing a more analytical approach has required what I often describe as an “awareness-building dance.”
There is a balance between honoring leadership’s desire to move quickly and helping them understand the value of a data-driven assessment.
Until leaders recognize the need for that analysis, and develop the desire to incorporate it, moving directly to implementation will likely produce inconsistent results.
When Awareness Isn’t Fully Established
I am working with an individual recruitment leader whose physician recruitment function was moved under the broader Talent Acquisition (TA) structure. The transition created significant frustration within the team.
What became clear during coaching conversations was that the leaders themselves had not fully aligned with the “why” behind the organizational decision. Without that clarity, it was difficult for them to help their teams make sense of the change.
During one session, a leader finally articulated the rationale:
“The organization did this to gain more accountability between the dollars spent and the number of physicians recruited.”
That realization shifted the conversation. The change was not simply structural, it reflected a shift toward greater performance accountability.
For recruiters, this meant they could no longer rely on using the marketing resources the way they always had. Now they needed to deepen their relationships with clinical leaders to solicit more in depth information about their opportunities to justify the promotional expense or convince them that the investments already made should illicit the desired candidates. For these recruiters, success required a different mindset—one that emphasized strategic thinking, stronger questioning skills, and negotiation tactics.
Once that awareness emerged, the leaders were better positioned to help their teams recognize that they were not being denigrated but rather emphasizing the skills that go beyond a standardized work process.
Change Happens One Stage at a Time
The ADKAR framework reminds us that change doesn’t happen all at once. Individuals move through it step by step.
When leaders feel stuck, the problem is often not effort or capability, it is that the process has jumped ahead of where people actually are in the change journey.
Slowing down to build awareness and desire may feel inefficient in the moment. In reality, it is what makes meaningful and sustainable change possible.
If you are navigating change within your team or organization and finding that progress feels uneven, it may be worth taking a closer look at where you are in the journey. For more information on our leadership coaching work, visit the Leadership Coaching Page or reach out to start a conversation at info@barlowmccarthy.com.