Victoria LaRosa, Sr. Principal Change Management Consultant, Oracle Mark Zarella, Research Assistant Professor, Drexel University College of Medicine


Although whole slide imaging (WSI) is a relatively mature technology and is even part of a system that has gained recent FDA approval, its utility is inherently limited by the applications that support it. Image capture only serves a useful purpose if the acquired images are harnessed in some way to make pathology workflows more efficient and organized or to provide new diagnostic benefits unrealizable by existing techniques. Several vendors have hit the marketplace with offerings that include efficient WSI viewing and annotation, image management, data integration, etc. Advanced methods in image analysis and machine learning have also been developed that have revealed the predictive information present in histology images, analogous to (and sometimes rivaling) ‘omics approaches. Although the ability of image analysis to be generalized with other data sets has sometimes been called into question, this isn’t a problem unique to image analysis – several popular gene expression assays, for example, have exhibited similar imperfections in reproducibility across data sets, yet they continue to be a mainstay in pathology.


So how can whole-slide imaging carve out a more prominent role in pathology practice and gain widespread acceptance? How can these tools with clear potential to provide unique diagnostic and prognostic information be integrated into the pathology workflow? The answer, at least in part, is to effectively manage the change.


It takes a village to make change happen


The first step to managing any change is to clearly define the reasons for and benefits of the change, including the quantifiable metrics that will allow you to track progress and measure that you have successfully changed. You should ask yourself: why do I want to make this change? What tangible and intangible benefits does it offer to those involved?  Defining the reason and value of the change at the start is the critical enabler of the next step in managing change – building buy-in.


Change can start with one person and one idea, but it will not actually occur until you get your “village” on board. Building buy-in is about getting others motivated and excited for this change – getting people to see it the way you see it and the value that will come from it. If you have a clear value proposition, building the buy-in is not the hardest part; sustaining buy-in is. Once you start sharing the vision for change and its benefits, you may gain initial acceptance and leave your first encounter certain that everybody is on board. So you start taking steps to initiate the change, go back to engage the very same people who were initially on board and find that they forgot all about it, moved on to something else, or just aren’t as interested because their peers are no longer engaged. What does this mean for you when you are trying to enact change?


  • Building buy-in is a continuous ongoing process.
  • Getting buy-in from the most influential people is critical (“influential” = a person who people listen to and respect, not just someone in a position of power).
  • Communication is essential. Keep sharing the reasons and benefits (WIIFM – what’s in it for me) to individuals and teams, and enlist your influential people to do the same.  The information will stick if people hear it multiple times and in different ways (you, their peers, in-person, electronically) so that it becomes a part of their everyday thinking.


If your messages about value and benefits are not resonating, go back to the drawing board and come up with a better vision and clearer benefits. These are rarely once and done.  They should be revisited as new data and insights are gained that add clarity to why things need to change.


Implementing the change


Now that you have brought key stakeholders on board, what’s next? First, keep those buy-in sustainment activities going. Involve people in the process and decisions of the change.  No one wants to feel like they are being told how to change. Next, start defining the specific details of the change. Take a close look at the current state, outline your ideal future state, and then record the gaps between the two. These gaps represent the change, but so are the many effects that closing those gaps will have on other processes, systems, roles, and policies. Look at change holistically and not in a vacuum. This allows you to identify and solve for the majority of impact to the people involved. For example, introducing whole-slide imaging as a routine step in the laboratory workflow may also alter procedures downstream – for example, with a virtual slide available, residents may no longer have exclusive first access to the slide. This can have a trickle-down effect on the interactions between residents and attendings, in effect extending the change impact beyond the laboratory. Understanding these impacts will provide clarity on what people need to do differently across all aspects of their daily interactions and activities.


It is important to recognize that the mental change started at the building buy-in step. It is at that stage when a person’s thoughts and potentially behaviors start to shift. To continue the change process, we have to plan for the change. This can take place by installing new technology, reengineering a process, changing job descriptions, etc. To successfully execute on these, you must plan for all the activities required to close the gaps discussed above, including a plan for how you intend to communicate and train people on this new way of working. People seek clarity in times of change, so plan to give it to them. Your plan should include the specific tasks required to close the gaps, how you intend to communicate and educate people, as well as who is going to help execute on these activities and within what timeframes. Be sure to highlight any key risks you see to execution of this plan, including resistance to change. Resistance to change will arise before, during, and after change occurs.  It is important to manage this resistance by trying to identify it before it arises, listening when it does arise (because you may learn something you didn’t know), and continuing to build buy-in through speaking and acting out the vision.


Takeaways for your change journey


People do not change overnight. It takes time and effort for the new ways of working, especially paradigm shifts, to become a part of an individual’s daily thoughts and behaviors. Managing people through a transition requires acceptance of what is being lost by leaving the current ways behind, allowing time to come to terms with that loss so they can let go of those emotions and focus on what is to come. The feeling of losing something you are comfortable with can be powerful and it must be recognized as part of the process to change. For change that isn’t immediately replaced with something else, the time between loss and acceptance will take longer.  Acknowledge it and allow people to go through it. As people begin to see the value in the change they will come to accept it and they will help to bring others on board too.


Disclaimer: In seeking to foster discourse on a wide array of ideas, the Digital Pathology Association believes that it is important to share a range of prominent industry viewpoints. This article does not necessarily express the viewpoints of the DPA, however we view this as a valuable point with which to facilitate discussion.