Journal of Womens Health, Issues and CareISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 5 Issue: 5

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

Tan SQ1, Lim WW1, Liu SL2, Phoon WLJ2, Tan TY2, Viardot V2, Chan J2, Nadarajah S2 and Tan HH2
1Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore
2Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore
Corresponding author : Shu Qi Tan
Senior Resident, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road-229899, Singapore
Received: April 19, 2016 Accepted: June 22, 2016 Published: June 27, 2016
Citation: Tan SQ, Lim WW, Liu SL, Phoon WLJ, Tan TY, et al. (2016) Kotter’s Eight-Step Change Model: One Centre’s Experience for Transition to the GnRH Antagonist Protocol. J Womens Health, Issues Care 5:5. doi:10.4172/2325-9795.1000246


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.

Keywords: IVF protocol; Transition; Kotter’s transformation

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