Harnessing the Power of Social Proof to Maximize Success: How Physician Leaders Can Avoid the Catastrophe of Failed Organizational Change Campaigns

Change is inevitable in healthcare systems, and often, surviving and thriving through the change depends on deploying a deliberate strategy. Physician leaders can position themselves for success by combining prominent change management methods (e.g., Prosci ADKAR®(1)) with social influence theoretical models, such as social proof theory, which has been extensively studied and found to strongly correlate with why and how people make choices.(2,3,4) Although used widely in sales and marketing industries, little attention has been paid to its potential in the healthcare setting. Whether a needed change is small, such as adjusting a clinical workflow to maximize care value, or large, such as health system mergers or reorganization, physician leaders can add these change management multipliers to maximize the success of the intended change.

Social Influence and Social Proof Theory

Social influence theory is a broad theoretical model used to describe how social context shapes human behavior. Presently, social influence, a field of extensive behavioral sciences research, has expanded into other related theoretical models, including social proof, coined by research psychologist Robert Cialdini in 1984.(5) Despite any imperfections inherent in social and behavioral research, these principles have been widely studied and found to influence a person’s decisions and behaviors.(2,4) Simply put, it explains the tendency for people to do things because others are doing them. In daily life, this could range from purchases based on the likability or credibility of the salesperson to a decision made based on group identification, such as sports teams, professional organizations, or political parties.

Specific examples of social proof that can be applied in healthcare settings include:

• Similarity. The “other” people are similar (e.g., shared identity, values, views, interests, circumstances, etc.).

• Likability. The “other” people are likable.

• Credible Authorities. The “other” people are credible authorities.

• Size. The larger the “other” group is, the more likely an individual is to follow the leader of the pack.

Review: Prominent Change Management Models

Prosci, more popularly referenced as the ADKAR (Awareness, Desire, Knowledge, Ability, and Reinforcement) model, is one of the commonly employed change management methods.(4) The main premise focuses on “six essential questions” that are designed to elicit an individual’s personal desire to change (“what’s in it for me”) through predictable phases of change adoption. The six essential questions are:

1. What is changing?

2. Why is it changing?

3. Why is it changing now?

4. What is not changing?

5. What are the individual and organizational risks of not changing?

6. What are the individual and organizational benefits of the change?

As the number of individuals committed to the change increases, the larger group reaches a tipping point that creates momentum for enterprise-wide change.(6)

Even when physician leaders use well-developed change management strategies like Prosci, employees may still resist change for a variety of reasons, which include:

• Any factor or event that inadvertently delays or prolongs one or more of the phases of change (readiness, implementation, transition, sustainment).

• Shifting factors internal to organizations, such as changes in the availability of resources, leadership transitions, etc.

• Factors outside organizational control, including national and regional political forces such as elections, national/regional policy or legal change, catastrophic weather events, etc.

However, employing elements of social proof can mitigate both anticipated and unanticipated resistance to meaningful large-scale change by influencing employees to embrace change more enthusiastically and deliberately.

Practical Application: A National Change Campaign

In the fall of 2024, as one of several interdisciplinary teams charged with improving staff efficiencies and productivity in the Veterans Health Administration (VHA), the team embarked on a national project to change supervisors’ behavior. The aim was to increase supervisors’ choice to use a VHA intranet site that offered an array of supervisor training resources designed to promote employee engagement.

The category of employee engagement was chosen because it strongly correlates with employee and organizational efficiencies and productivity.(7,8) The team was aware of the competing demands common to supervisors at all levels, which threaten the adoption of new behaviors, including those that ultimately create efficiencies.

Step 1: Initial foundational approach and actions — standard considerations for venue and presentation content.

VHA is the largest integrated healthcare system in the United States, with approximately 380,000 employees providing care to 9.1 million enrolled patients.(9) Because of its size and complexity, the team initially identified audiences for communication and change campaigns through the pre-established informational meeting structures of the VHA’s 18 regions, known as Veterans Integrated Service Networks (VISNs). Using VISNs to reach the maximum number of employees is common, as these lines of communication mirror the VHA systems of care, increasing the probability of successfully informing the largest number of supervisors.

Change management elements were deliberately incorporated into presentations to maximize the potential to modify behavior. These included elements of Prosci, such as ADKAR, the six essential questions, and the “what’s-in-it-for-me” to more successfully increase supervisors’ awareness and use of the employee engagement resources.

Step 2: Use of communities of practice as platforms to integrate social influence strategies and expand and intensify the reach of the change campaign.

In VHA, communities of practice (CoPs) are formal and informal social systems based on common professional roles and interests. These communities provide employees with a variety of forums through which to connect with others via email groups, recurring meetings, special sessions, training, and mentoring.

The project team identified these communities as an opportunity to both increase the number of individuals exposed to presentations and to positively leverage social influence strategies.(10 )This approach was intended to exponentially increase the use of resources by supervisors.

Use of CoP to integrate social proof strategies.

The team developed specific presentation resources using combinations of social proof elements:

• Similarity + Credible Authority. Presenters volunteered or were selected if they were already known to the group, either as a leader or peer, and/or shared occupational or organizational similarities (worked in the same profession, office, or division).

• Similarity + Likeability. Video creation: Two friendly, supportive, and open-minded supervisors discussed the resources in a short, animated video. One supervisor introduced the resource to the other, describing how and why they used it and what they liked about it.

• Credible Authority. Video creation: These are one- to two-minute leadership testimonial videos with executive, senior, and mid-level supervisors describing why and how they used the intranet site, including how they felt the resources improved their leadership effectiveness.

• Similarity + Likability + Credible Authority. Video creation: A positive and enthusiastic “how-to” video created and presented by a credible and friendly senior leader demonstrated how to quickly and easily access the training resources.

Use of CoP to expand and intensify the campaign.

In addition to formal communication channels, the project team identified as many related groups as possible for presentations by exploiting the interdisciplinary nature of project members and their leadership influence. As a result, presentations were expanded from the typical VISN communication channels, which mirrored health system organizational units (about 2,500 employees), to an estimated 1,000 more by adding the following entities:

• Role-based communities of practice, such as a human resources supervisor group and/or a chief mental health officers group.

• VHA central office workgroups and communities with senior and national program-level supervisors.

• VHA national governing boards with interdisciplinary senior leader representatives.

The campaign reach was then intensified through presenter enthusiasm (likability + similarity + credible authority) and through invitations by some presenters that encouraged audiences to request additional presentations if desired.

As an example, one senior physician executive presented to approximately 2,300 employees attending the weekly VHA Hotline Call, which resulted in requests for additional presentations to approximately 200 more employees through regional and local supervisor-specific CoPs. In addition to increasing the number of employees exposed to the change campaign, the audiences were exclusively supervisory employees, which generated additional audience interest and engagement.

Results

Although expansive analytics were not possible based on the inherent capability of the application-based site of resources, the team was able to measure changes in the number of total and unique users on presentation days. For example, on the day of the presentation to approximately 2,300 employees, data showed 349 site visits, of which 276 were unique users, a seven-fold increase above the average hits to the application site on non-presentation days in the preceding two weeks.

Although more research is needed to examine the associations of supervisor behaviors specific to both presentation days and days over time, as well as objective correlations with employee engagement, the project team was able to establish preliminarily that the presentation was associated with a significant increase in employees accessing the resources.

Implications for Physician Leaders

Physician leaders can leverage elements of social proof, such as credibility inherent in their professional role (as well as likeability and similarity), and potentially increase the chance that employees approach change with enthusiasm and interest rather than resistance. Another method for practical implementation may involve identifying communities of practice as platforms to exert social proof strategies, which can potentially broaden and intensify the campaign to maximize successful large-scale change.

Conclusion

Although large-scale organizational change may be threatened by a variety of confounding factors, social influence strategies can mitigate risks to change adoption and maximize leaders’ effectiveness in managing change. At VHA, combining both strategies led to a larger-than-anticipated success, increasing supervisors’ use of a valuable resource designed to maximize employee efficiency and productivity.

Acknowledgment: Special thanks to project team colleagues and collaborators Katharine Smidt and Christopher K. Ebert.

References

1. The Prosci ADKAR® model: a powerful yet simple model for facilitating individual change. Prosci. Accessed February 22, 2026. https://www.prosci.com/methodology/adkar .

2. Goldstein NJ, Cialdini RB, Griskevicius V. A room with a viewpoint: using social norms to motivate environmental conservation in hotels. J Consum Res. 2008;35(3):472–482. https://doi.org/10.1086/586910 .

3. Venema TAG, Kroese FM, Benjamins JS, de Ridder DTD. When in doubt, follow the crowd? responsiveness to social proof nudges in the absence of clear preferences. Front Psychol. 2020;11:1385. https://doi.org/10.3389/fpsyg.2020.01385 .

4. Huang H. Persuasion and virality: a systematic literature review of Cialdini’s principles of persuasion and contents that go viral on social media. University of Oulu. 2025. Accessed February 22, 2026. https://urn.fi/URN:NBN:fi:oulu-202506194814 .

5. Cialdini RB. Influence. New York: William Morrow and Company;1984.

6. Moussaïd M, Kämmer JE, Analytis PP, Neth H. Social influence and the collective dynamics of opinion formation. PLoS One. 2013;8(11):e78433. https://doi.org/10.1371/journal.pone.0078433 .

7. Markos S, Sridevi MS. Employee engagement: the key to improving performance. Int J Bus Manag. 2010;5(12):89. https://doi.org/10.5539/ijbm.v5n12p89 .

8. Rich BL, Lepine JA, Crawford ER. Job engagement: antecedents and effects on job performance. Acad Manag J. 2017;53(3). Accessed November 10, 2025. https://doi.org/10.5465/amj.2010.51468988 .

9. Veterans Health Administration. About VA. Accessed February 22, 2026. https://www.va.gov/health/aboutvha.asp .

10. Carpenter D, Hassell S, Mardon R, Fair S, et. al. Using learning communities to support adoption of health care innovations. Jt Comm J Qual Patient Saf. 2018;44(10): 566-573. https://doi.org/10.1016/j.jcjq.2018.03.010 .