Gainsharing offers a hospital a way to control costs by using incentive payments to engage physicians in efforts to improve cost and quality performance. Author John Kotter's eight stages of change management can serve as a framework for understanding how the New Jersey Hospital Association and the Greater New York Hospital Association have guided the successful implementation of gainsharing. Successful gainsharing fosters a culture of improvement that capitalizes on the creativity, knowledge, and problem-solving ability of physicians to implement change and create added value.