HCA 699 Topic 2 DQ 2: creating a culture of change guide
A discussion response on how a leader creates a culture that allows for new ways of knowing. This guide covers the premise in the prompt that is worth contesting, why a culture is not a change initiative, and the mechanisms a culture-level answer has to name instead of intentions.
Editorial process
Last reviewed · August 6, 2026
The premise in the prompt is the trap
The prompt hands you a premise and a question, and the premise is the trap. Accepting "nobody likes change" as the thing to be overcome produces an answer about resistance. The question asked about something else.
Read the middle clause again: creating a culture that allows for new ways of knowing. That is not a description of resistance management. Knowing is a learning word, and a culture that allows for it is one where people can say what they have noticed without cost. So the question is about the conditions under which an organisation can learn — surfacing error, reporting near misses, questioning a protocol, admitting an idea did not work. An answer built on breaking down resistance treats staff as the obstacle. An answer built on learning treats their silence as the obstacle, which is both more defensible and closer to what the prompt actually said. The premise is worth contesting in a sentence too: the evidence is that people resist loss, imposed change and uncertainty, not novelty as such.
The second trap is the word culture. A culture of change is a standing capability — the organisation's ability to absorb the next change, and the one after that — and it is not the same thing as a change initiative. Almost every response to this prompt describes a staged change model applied to one project: build urgency, form a coalition, communicate the vision, generate short-term wins. That is a competent answer to a question about running a change. It is not an answer to a question about creating a culture, and the difference shows up in the last step of those models, which is anchoring the new approach in the culture — the step implementation studies most often find missing in practice. If your answer stops at the wins, you have described the part everyone already does well.
What a culture-level answer actually contains is mechanisms rather than intentions. Not "I would foster open communication" but the specific arrangements that make speaking up survivable: how error is responded to the first time it is reported, whether the person who raised a problem is named as its owner or thanked for raising it, whether trying something that fails costs anyone anything, whether the most junior person in the room is asked first or last. Hierarchy matters here and is worth naming — the people furthest down a clinical hierarchy find it hardest to speak to those above them, so a leader who only opens the floor has not changed who fills it. Structures that rotate who speaks first do more than invitations do. A useful test for any sentence in this section: could a new hire tell, in their first week, whether the thing you described is true here? If not, it is an intention.
Finally, the prompt says As a leader, how would you, which is first person and asks for a course of action. A summary of what the literature says about change leadership answers a different question. Name the moves you would make, in order, and say what each is for: what you would do in the first month to find out what people are not telling you, what you would change about how error is handled, what you would measure to know whether it worked, and how you would keep it once attention moves on. The measurement point is where most answers thin out, and it is the one that separates a culture claim from a hope — a culture you cannot detect a change in is one you cannot say you built. Naming an interval matters as much as naming the indicator.
What the answer usually does | What the prompt asked for |
|---|---|
Accepts that people dislike change and plans to overcome it | Contests the premise: people resist loss and imposition, not novelty |
Applies a staged model to one project | Describes a standing capability that survives the project |
States intentions — open communication, trust, transparency | Names mechanisms — how error is answered, who speaks first, what failure costs |
Summarises what the literature recommends | Says what you, as the leader, would do and in what order |
Ends at short-term wins | Ends at anchoring and measurement, the steps most often left undone |
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Distinguish a standing organisational capability from a single change initiative.
- 02Identify the conditions under which staff will raise problems rather than absorb them.
- 03Replace stated intentions with named mechanisms when describing leadership action.
- 04Propose a way of measuring a cultural change rather than asserting it occurred.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. HCA 699 Topic 2 DQ 2 I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
What this discussion response has to do
- 01A discussion response answering how you would create a culture of change.
- 02A leader's-eye account in the first person, as the prompt's wording asks for.
- 03Specific actions rather than a summary of the change-leadership literature.
- 04Support from sources, per the course's discussion posting requirements.
From contesting the premise to measuring the result
Take the premise apart in one sentence
Note what people actually resist — loss, imposition, uncertainty — so the rest of the answer is not built on the folk claim.
Define what a culture of change would look like if you had one
Describe the observable behaviours: problems surfaced early, protocols questioned, failed attempts reported without cost.
Name the mechanisms you would put in place
How error is answered, who is asked first, what a failed experiment costs, how raising a problem is rewarded.
Address hierarchy directly
Say what you would change so that the people least likely to speak are heard, rather than assuming an open door is enough.
Say how you would know it worked
Propose an indicator — reporting rates, staff survey items, whether raised problems get resolved — and a review interval.
Where the evidence on speaking up and anchoring lives
Recommended databases
- PubMed / PubMed Central
- Course text on health care leadership
- AHRQ patient safety resources
Search sequence
- 1.Look up what change-management models are actually found to achieve in health care settings, including which steps go undone.
- 2.Read on psychological safety and speaking up, since that is the mechanism behind new ways of knowing.
- 3.Find evidence on hierarchy and voice before writing the section on who speaks.
Sources for change models and psychological safety
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare
PubMed Central, US National Library of Medicine · 2021
What change models are used for in health care and where they overlap with improvement and implementation science. Use it to justify treating a model as one tool rather than as the answer to a culture question.
- 02
A Change-Management Approach to Closing Care Gaps in a Federally Qualified Health Center: A Rural Kentucky Case Study
PubMed Central, US National Library of Medicine · 2019
A real implementation in which the first seven steps were evidenced and the eighth — anchoring the change in the culture — was identified as the gap. This is the citation behind the argument that the culture step is the one that goes undone.
- 03
The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis
PubMed Central, US National Library of Medicine · 2021
Evidence on what psychological safety does in health care and what shapes it. This is the source for treating 'new ways of knowing' as a question about whether people can speak, rather than about enthusiasm for change.
- 04
A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour
PubMed Central, US National Library of Medicine · 2020
What has actually been tried to improve speaking up, and what the reviewers concluded interventions need — visible leader support, group and organisational targeting. It converts the mechanisms section from invention into evidence.
Before the post goes up
Common mistakes
- Accepting 'nobody likes change' as a fact to be overcome rather than a premise worth testing.
- Describing a staged change model applied to one project, which answers a question about running a change rather than building a culture.
- Stopping at short-term wins and never reaching anchoring, which is the step implementation studies most often find missing.
- Offering intentions — open communication, trust, transparency — where the question needs mechanisms.
- Ignoring hierarchy, so the answer assumes an open floor will be filled evenly.
- Summarising the literature instead of answering in the first person the prompt uses.
- Leaving out any way of telling whether the culture actually changed.
Submission checklist
- The premise in the prompt is addressed rather than assumed.
- The answer distinguishes a culture from a single change initiative explicitly.
- At least three concrete mechanisms are named, not intentions.
- How error and failure are responded to is covered, since that is what makes speaking up survivable.
- Hierarchy is acknowledged as a barrier to who speaks.
- The response is written in the first person the prompt asks for.
- A means of measuring the change is proposed.
- Sources support the claims, per the course's discussion requirements.
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Written by
Aaron Bishop
MA, Education
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Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
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PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.