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Abstract
In 1969 Elizabeth Kubler-Ross described the five stages of dying, which helped people understand and better help those who were dealing with death and bereavement. Similarly, there are very clear stages of evolution in a medical staff when they are asked to adapt national quality standards, and to respond to a call to action to eliminate entities that have been well-entrenched and accepted as a normal part of inpatient care such as ventilator-associated pneumonia, central line bloodstream infection, etc. There seems to be common ground in accepting change in that if you examine the reaction of the medical staff to these issues, they mimic closely the stages as described by Ross. The stages are: 1. denial, 2. anger, 3. bargaining, 4. depression, and 5. acceptance. The management of implementing quality initiatives needs to be done in a thoughtful manner, cognizant of the sometime complex but manageable reaction that physicians have to change.