In May 2006, a family clinic in Garland, Texas, switched on a new electronic health record. About three hours later, the server crashed, and the system stayed down for the rest of the day.
The clinic, Family Medical Center at North Garland, was the first pilot site for HealthTexas Provider Network, the outpatient arm of Baylor Health Care System, which planned to move all 88 of its centers onto one electronic record by December 2008. Each doctor’s schedule had been trimmed by only two to four patients per session. Now the physicians faced an almost full caseload with no complete records for those patients. The clinic worked on paper for most of the day.
North Garland had used an earlier electronic system since 1997. Most of the network would be moving from paper for the first time, and policy made the new record mandatory for every patient visit once a practice went live. When researchers later tracked 26 primary care practices that went live between June 2006 and December 2008, they found that in the first six months, the work billed per full-time doctor had fallen about 8 percent.
Nobody could yet say whether that 8 percent was a hole the practices would climb out of, or the new floor.
Down, then climbing back
By twelve months, the 26 practices had regained half the lost ground. Productivity sat about 4 percent below where it had been. Practices that went live in 2006 and 2007 recovered completely after a year. Those that went live in 2008, the year the recession hit, had not recovered by the end of the study, and the authors could not tell how much of that gap came from the recession.
That is the shape the workplace “change curve” tries to draw. Imposed change can bring a dip before people adapt, but there’s no fixed script. How deep it goes, how long it lasts, and whether the line comes all the way back depend on the people and on everything else happening at the time.
Much of the dip is plain mechanics. The old way was fast because nobody had to think about it. The new way has to be learned while the work keeps coming. In this network, getting ready took an average of 134 hours of staff time per physician, counting doctors, clinical staff and the front desk. Move into a new kitchen and dinner takes longer for a few weeks, not because you forgot how to cook but because every drawer is in the wrong place.
Borrowed from a deathbed
The curve on consultants’ slides usually comes labeled with feelings: denial, anger, bargaining, depression, acceptance. Those stages come from Elisabeth Kübler-Ross’s 1969 book On Death and Dying, which drew on her contact with “over two hundred dying patients.” One later reappraisal called the book “a collection of case studies in the form of conversations with dying patients.”
The people who carried the stages from the deathbed to the restructure were mainly change management consultants, writes Todd Bridgman, a management professor at Victoria University of Wellington, who traced the model’s history with Logan Holdsworth in 2025. Prosci, a change management firm that suggests pairing the curve with its own methodology, says the curve “isn’t founded on change management research.”
Research on grief doesn’t back a fixed sequence either. The Yale Bereavement Study followed 233 bereaved people in Connecticut for up to two years. On average, five grief indicators did peak in the order the stage theory predicts. But acceptance was the most common response from the first month on, and the dominant negative feeling was yearning, not disbelief. The study drew strong criticism, and a 2017 review led by Margaret Stroebe found “little to support the sequential development of these in stages.”
George Bonanno and colleagues had data on 205 older married people in the Detroit area from years before a spouse died, then 6 and 18 months after. The most common pattern, at 45.9 percent, was resilience: depression stayed low throughout. The familiar arc of distress that rises and slowly fades fit 10.7 percent.
Kübler-Ross herself, writing with David Kessler in 2005, said the stages “are not stops on some linear timeline in grief.” And a reorganization is not a death. Most workplace changes involve choices, Bridgman notes, including keeping the old way. How the outer change differs from the inner adjustment is the subject of transition.
The complaint that wasn’t a stage
Imagine a practice manager six weeks into a new scheduling system. One senior nurse keeps raising the same complaint: the new template double-books follow-up visits. On the change-curve poster in the break room, that looks like anger, maybe denial. File it there, wait for her to reach acceptance, and the double-booking stays.
This is the misreading Bridgman warns about. Someone may object because, from experience, they believe a change is “unnecessary, poorly conceived, unethical, or even illegal,” and the curve would diagnose them as in denial. The colleague who seems fine may not be hiding anything either. In Bonanno’s data, staying steady was the most common pattern.
Baylor’s researchers later read the rollout through numbers instead: monthly billing, staffing and income, practice by practice. Those showed how deep the dip was, how fast it closed, and where it still hadn’t closed when the study ended.
North Garland’s rough first day changed something practical, too. Its clinicians had had four hours of training in total; at later clinics, the requirement for physicians and clinical staff was ten.