Issue 3/2026
Todorov1, 2, I.
1 „Dr. Shterev“ Hospital – Sofia
2 Bоurgas State University “Prof. dr. Asen Zlatarov” – Bourgas
This paper provides an analytical review of integrated change management in a hospital setting, using the case of “Dr. Shterev” Medical Complex aimed at transforming maternity care and sustainably increasing vaginal birth rates. Drawing on established change management concepts (phased approaches, systems thinking, and institutionalization), the article examines: the specific challenges of change in healthcare organizations; the hospital profile and organizational context; drivers for transformation; the chronology and strategy (2019-2024); structural and process interventions; challenges and mitigation (including during COVID-19); mechanisms of internal mobilization and staff engagement; and external communication with patients and the public, including the campaign “It’s natural to seek joy”. Impact is illustrated through a key performance indicator (KPI) – the proportion of vaginal births-shifting from 16 % in 2013 to a sustained 64-68% during 2020-2024. The discussion argues that durable improvement results from an integrated bundle of organizational measures (structure, processes, incentives, infrastructure, and communication) rather than a single isolated intervention.
Key words: change management; hospital management; organizational transformation; maternity care; vaginal birth; cesarean section; KPI; organizational culture.
Address for correspondence:
Ivan R. Todorov
Administrative Director, Dr. Shterev Medical Complex
25-31, „Hristo Blagoev”, Str.
1330, Sofia
e-mail: i.todorov@shterevhospital.com