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The Kübler-Ross cycle

Quality Tools > Tools of the Trade > 53: The Kübler-Ross cycle


Elisabeth Kübler-Ross was a Swiss doctor who, in the 1950s and 1960s, noticed that other doctors, when they discovered that one of their patients was terminally ill, would ignore them. It was as if the doctors felt they could better spend their time with people they could treat (or maybe they were just retreating from what they saw as their failures).

Rather than do the same, she spent time with these patient, both comforting them and studying them. In this study, she found a cycle of emotions that seemed common to most people affected by the traumatic news of their impending deaths. She wrote about this in a book entitled ‘On Death and Dying’ and gained fame as she promoted the need for care of the terminally throughout the medical profession.

Much as Juran took Pareto’s economic rule and applied it to quality, so Darryl Conner at ODR took Kübler-Ross’ cycle and applied it to change, showing how people given any negative news would also tend to react in a similar way. In the same way that Kübler-Ross helped dying people through these stages, so it can also be used to both understand and help move people in change to a state of positive acceptance.




On first hearing bad news, the first thing that happens is nothing. To the bearer of the bad news this can seem like the job was easy, but in fact people may have fallen into an inner state of trauma which has not yet reached the surface.



The next stage is more nothing. Or at least no glimmer of acceptance of the change. This is where people carry on with their jobs and lives as if nothing had happened. When confronted with the stark reality, they are likely to turn away or pretend that it just isn’t there.

People can get stuck in denial, sometimes for years, and they will only move on when there is absolutely no way of avoiding the situation.



When they finally realize that the change is going to happen, the emotion that had been bottled up during denial now explodes out. People are angry at the system, the unfairness, and anyone who gets in their path.

The best way to treat such anger is to let it happen. Do not push them back into denial. Do not take it personally. Just accept the person and allow the storm to  blow itself out—which it will do in the end, even if it re-appears from time to time before finally giving out.



When they calm down, they then start thinking more rationally and try to find a way out. They will offer to do anything, from taking pay cuts to learning new skills – often things that would have been anathema before the change.

Again, the best action here is not to give them false hope. Answer their requests seriously (and maybe there are things that can be agreed) and show that the change cannot be stopped.



Now that they realize that the change is inevitable and that they cannot escape it, the people affected will fall into a state of depression. They may become static and could seem like they have gone back to denial (which can happen).  They may cry or become withdrawn.

The best you can do for the depressed is to be there, accept them and gently help them forwards as they become ready. If necessary, they should seek medical help. Suicides at this stage, although thankfully uncommon, are not unknown.



As they work out new mental models and ways of viewing the world, the people now will start to try out these ideas. They may start acting differently, work differently and think differently. They may experiment and aim to discover the ‘new person’ or what works for them now.

This stage is, of course, to be supported. Give them positive help to move them forwards. Get them to talk with others who have succeeded. Let them find that the new dawn is better than they had guessed.



Finally, they reach the stage of a fully functioning human being again. The journey might have been tough but they have made it through.

As a supportive Change Agent, you may now look in on them from time to time, but your work is now elsewhere, helping other through their difficult times.


In practice, people can go through this cycle in seconds or it can even take years. Factors which affect this rate include the severity of the news (or at least the severity of the interpretation) and the personal characteristics of the person involved that helps or hinders them in reaching acceptance.


Next time: Lewin, push and pull



This article first appeared in Quality World, the journal of the Institute for Quality Assurance

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