Abstract
BackgroundHypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success.ObjectivesThrough implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change?Study designEach intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation.ResultsKey ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses.ConclusionsThe model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.
Highlights
Hypertension is prevalent and often sub-optimally controlled; interventions to improve blood pressure control have had limited success
Negative organizational characteristics likely to impact organizational readiness to change (ORC) included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic
This model posits that organizational readiness for change is the product of two constructs: change valence, or the degree to which organizational members value the proposed change; and informational assessment, or the degree to which organizational members know what tasks are involved in the change, have enough resources available to implement the change, and view positively situational factors such as the timing of change and the time available for implementation
Summary
Hypertension is prevalent and often sub-optimally controlled; interventions to improve blood pressure control have had limited success. Evidence-based mechanisms for controlling hypertension include a healthy diet, adequate exercise, and medication management [1]. Despite the prevalence of hypertension and evidence on effective management of hypertension, it remains a serious public health problem [3,4]. This is true among the US veteran population where approximately 25% to 40% of veterans with hypertension in 2007 had a blood pressure (BP) measurement ≥140/90 mmHg [5]
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