Kotter's Eight-Step Change Model: One Centre's Experience for Transition to the GnRH Antagonist Protocol

Background: Gonadotropin releasing hormone (GnRH) agonist cycle was the traditional method of ovarian stimulation at KK Women’s and Children’s Hospital IVF Centre. This long cycle involved many injections, with a poor side effect profile. The GnRH antagonist cycle was introduced in year 2000, with fewer injections per cycle and better side effect profile.
Aim: Our department aims to encourage transition from the GnRH agonist cycle to GnRH antagonist cycle, with complete changeover by 2013. Methods: The transformation process was organized according to Kotter’s Eight-Step Change Model from the first half of 2012.
Results: This transition led to a five times reduction in the number of oocyte pick-ups on a non-working day. This reduced out-of-hours demands, while maintaining the pregnancy and live birth rates. Incidence of ovarian hyper stimulation syndrome was reduced from 4.0% to 2.2%. By early 2013, 77.2% of ovarian stimulation was done with GnRH antagonist cycles.
Conclusion: Kotter’s Eight-Step Change Model was useful to encourage positive transformation. Garnering support from the various users was essential for the transition to GnRH antagonist cycles, which led to enhancement in different dimensions of clinical quality including patient centered processes, effectiveness of treatment and efficiency of service, while maintaining patient’s safety.