Why Organizational Change Matters for Equity
In the pursuit of health equity, change must begin within organizations. Organizations across sectors — from healthcare systems to academic institutions and community-based organizations — are recognizing that advancing equity requires more than good intentions. It demands a shift in how we lead, partner, and share power. This blog explores how organizations are making that shift through practical strategies, community-rooted partnerships, and a commitment to co-creating systems that are equitable. It will include three key areas: frameworks as tools, not templates; embedding equity internally; and advancing organizational change. By understanding and implementing these approaches, systems can be created that truly serve all communities.
Frameworks as Tools, Not Templates
Frameworks like ADKAR and Kotter’s 8-Step Process help organizations plan and mange change. They emphasize the importance of building awareness, aligning stakeholders, and reinforcing new behaviors. But for equity-focused change, these models must be adapted to reflect the lived realities of communities and the need for shared leadership. Rather than treating frameworks as one-size-fits-all solutions, organizations can use them to guide internal reflection and structure efforts that are rooted in trust, transparency, and accountability.
For example, a change-management approach to closing health care gaps in a federally qualified health center in rural Kentucky demonstrates how intentional planning and the application of Kotter’s 8-Step Process can improve preventive care service delivery and reduce health disparities among patients. The center used disaggregated data to highlight disparities, creating a sense of urgency and aligning staff around the shared goal of advancing health equity. Through this structured approach, the clinic achieved a 20% increase in colorectal cancer screening rates among Black patients over 12 months. This example shows how structured change management can support equity-centered transformation by focusing on how people experience and adopt change, building staff engagement and capability, and aligning internal processes with community needs to improve health outcomes.
A systematic review of change management models in healthcare further reinforces the importance of adapting change frameworks to public health and clinical settings to drive sustainable, context-specific improvements.
Embedding Equity Internally
At the heart of equity-centered change is power sharing — a practice that shifts decision-making authority to those most affected by health inequities. Power sharing means:
- Co-creation: Designing strategies and solutions with, not for, communities
- Co-leadership: Sharing governance and leadership roles across sectors
- Mutual accountability: Building feedback loops and transparency into every stage of change
Power sharing is not a checkbox — it’s a cultural shift. It requires organizations to examine who holds power, how decisions are made, and whose voices are prioritized. This work is essential to building community power and advancing racial and health equity.
To sustain change, organizations must align their internal structures with their equity goals. This includes creating formal mechanisms for community input (e.g., advisory boards, participatory planning), and reviewing internal policies that may unintentionally reinforce inequities. Tools like equity impact assessments and disaggregated data to identify gaps and track progress over time. Leadership development is also a critical lever for embedding equity. The Health Equity Leadership Program at Massachusetts General Hospital exemplifies this commitment by equipping healthcare leaders to integrate equity into quality improvement, data collection, and patient engagement — demonstrating how leadership development can ripple across an organization to improve outcomes for diverse communities. Resources like the Health Equity Guide and our P4HE Resource Spotlight on Organizational Change offer tools for embedding equity into decision-making, resource allocation, and evaluation.
Advancing Organizational Change
Organizational change is often driven from within organizations but can also be sparked from the outside. Advocacy campaigns like the Time for $5 campaign, which successfully pressured Danaher Corporation to reduce the cost of tuberculosis diagnostics, show how public pressure, coalition-building, and community leadership can shift organizational priorities. The campaign enabled the procurement of five million additional tests for low- and middle-income countries and committed the company to annual third-party assessments. These movements remind us that community voice is not only essential within organizations, but also powerful in holding them accountable. Whether you’re an advocate, policymaker, researcher, funder, or community leader, you have a role to play in advancing organizational change for health equity:
- Academics and Researchers: Embed equity principles into policies, redesign curricula to reflect diverse perspectives, and foster partnerships that prioritize community voices.
- Advocates: Mobilize public support, elevate community voices, and apply pressure to institutions through campaigns, storytelling, and coalition-building to drive accountability and shift organizational priorities toward equity.
- Private Sector Organizations: Conduct equity audits, design inclusive workforce initiatives, and integrate community feedback into strategic planning.
- Governments and Policymakers: Develop funding mechanisms for equitable partnerships, promote transparency, and incentivize policies that prioritize equity.
- Philanthropies: Provide sustained, flexible funding to strengthen Community-Based Organizations (CBOs), invest in leadership development, and support systemic changes.
- Communities and CBOs: Advocate for inclusive roles in governance, participate in co-creation processes, and lead coalition-building efforts to hold organizations accountable.
Organizational change is not a one-time initiative — it’s a continuous commitment to equity, accountability, and partnership. By learning from these examples and applying these strategies, we can build systems that truly serve all communities.
Join the conversation!
- How is your organization shifting power and centering community voice in its equity work? Share your thoughts with us on social media on Facebook, Bluesky, LinkedIn, Instagram, and TikTok.
Interested in learning more?
- Explore our P4HE Resource Spotlight on organizational change for health equity — a curated list of tools, case studies, and frameworks to support your journey.
- Check out our Better Health for All resources that explore community engagement and power sharing as approaches for health equity in the philanthropy space.
- Stay tuned to our Learn page for registration information for our upcoming events.