Organizational Readiness For Implementing Change Research Articles

Diffusion of medications for opioid use disorder treatment in jail settings: a convergent mixed methods study of jail staff perspectives

BackgroundImplementation of medications for opioid use disorder (MOUD) in jails varies by facility and across states. Organizational climate, including staff attitudes toward change and exposure to education, can influence perceptions of innovations like MOUD in jails. Using a mixed methods design, we aimed to understand the association between organizational climate and jail staff perceptions of MOUD.MethodsJail staff (n = 111) who operate MOUD programs in 6 Massachusetts jails completed surveys that included the Organizational Readiness for Implementing Change (ORIC) survey. Random effects logistic regression models assessed associations between organizational climate and several outcomes of perceived MOUD efficacy, acceptability, and knowledge, while controlling for covariates. Jail staff (N = 61) participated in qualitative interviews and focus groups focused on organizational climate and knowledge diffusion, which we analyzed using inductive and deductive methods.ResultsThe results indicate that organizational change readiness on the ORIC was associated with positive perceptions of MOUD, and educational resources facilitated MOUD implementation. Greater ORIC was associated with higher perception of methadone as highly acceptable for jail populations (Odds ratio [OR] 2.3, 95% Confidence Interval [CI] 1.2 to 4.4), and high knowledge of methadone (OR 2.3, 95% CI 1.1 to 4.9), with similar magnitude of effects for buprenorphine. High levels of training for jail staff on methadone and buprenorphine were also associated with higher knowledge of these medications (Methadone: OR 7.2, 95% CI 2.2 to 23.2; Buprenorphine: OR 3.4, 95% CI 1.2 to 9.5). Qualitative results point towards the importance of organizational climate and elucidate educational strategies to improve staff perceptions of MOUD.ConclusionResults underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources as a facilitator of successful MOUD implementation in jail settings. Findings highlight implementation strategies that may improve jail staff perceptions of MOUD.

Psychometric properties of two implementation measures: Normalization MeAsure Development questionnaire (NoMAD) and organizational readiness for implementing change (ORIC).

Effective interventions need to be implemented successfully to achieve impact. Two theory-based measures exist for measuring the effectiveness of implementation strategies and monitor implementation progress. The Normalization MeAsure Development questionnaire (NoMAD) explores the four core concepts (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring) of the Normalization Process Theory. The Organizational Readiness for Implementing Change (ORIC) is based on the theory of Organizational Readiness for Change, measuring organization members' psychological and behavioral preparedness for implementing a change. We examined the measurement properties of the NoMAD and ORIC in a multi-national implementation effectiveness study. Twelve mental health organizations in nine countries implemented Internet-based cognitive behavioral therapy (iCBT) for common mental disorders. Staff involved in iCBT service delivery (n = 318) participated in the study. Both measures were translated into eight languages using a standardized forward-backward translation procedure. Correlations between measures and subscales were estimated to examine convergent validity. The theoretical factor structures of the scales were tested using confirmatory factor analysis (CFA). Test-retest reliability was based on the correlation between scores at two time points 3 months apart. Internal consistency was assessed using Cronbach's alpha. Floor and ceiling effects were quantified using the proportion of zero and maximum scores. NoMAD and ORIC measure related but distinct latent constructs. The CFA showed that the use of a total score for each measure is appropriate. The theoretical subscales of the NoMAD had adequate internal consistency. The total scale had high internal consistency. The total ORIC scale and subscales demonstrated high internal consistency. Test-retest reliability was suboptimal for both measures and floor and ceiling effects were absent. This study confirmed the psychometric properties of the NoMAD and ORIC in multi-national mental health care settings. While measuring on different but related aspects of implementation processes, the NoMAD and ORIC prove to be valid and reliable across different language settings.

Readiness to Implement a Doula–Hospital Partnership Program

ObjectiveTo assess obstetric clinicians’ and leaders’ baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula–hospital partnership program. DesignSurvey of obstetric clinicians and leaders before implementation of the doula program. Setting/Local ProblemAcademic medical center in Western Massachusetts that was preparing to pilot a doula–hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. ParticipantsObstetric clinicians and leaders (N = 48). Intervention/MeasurementsWe used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants’ knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. ResultsForty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. ConclusionOur findings suggested strong support for and readiness to implement the doula–hospital partnership program.

Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis

BackgroundThe Family in Intensive Care UnitS (FICUS) trial investigates the clinical effectiveness of a multicomponent, nurse-led interprofessional family support intervention (FSI) and explores its implementation in intensive care units (ICUs). The local context of each ICU strongly influences intervention performance in practice. To promote FSI uptake and to reduce variation in intervention delivery, we aimed to develop tailored implementation strategies.MethodsA mixed method contextual analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed from March to June 2022 on eight ICUs assigned to the intervention group. ICU key clinical partners were asked to complete a questionnaire on CFIR inner setting measures (i.e., organizational culture, resources, learning climate and leadership engagement) and the Organizational Readiness for Implementing Change (ORIC) scale prior to group interviews, which were held to discuss barriers and facilitators to FSI implementation. Descriptive analysis and pragmatic rapid thematic analysis were used. Then, tailored implementation strategies were developed for each ICU.ResultsIn total, 33 key clinical partners returned the questionnaire and 40 attended eight group interviews. Results showed a supportive environment, with CFIR inner setting and ORIC measures each rated above 3 (scale: 1 low—5 high value), with leadership engagement scoring highest (median 4.00, IQR 0.38). Interview data showed that the ICU teams were highly motivated and committed to implementing the FSI. They reported limited resources, new interprofessional information exchange, and role adoption of nurses as challenging.ConclusionWe found that important pre-conditions for FSI implementation, such as leadership support, a supportive team culture, and a good learning climate were present. Some aspects, such as available resources, interprofessional collaboration and family nurses’ role adoption were of concern and needed attention. An initial set of implementation strategies were relevant to all ICUs, but some additions and adaptation to local needs were required. Multi-component interventions are challenging to implement within complex systems, such as ICUs. This pragmatic, theory-guided, mixed methods contextual analysis demonstrated high readiness and commitment to FSI implementation in the context of a clinical trial and enabled the specification of a tailored, multifaceted implementation strategy.

Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics.

Financial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations. We conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality. Results from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources. Staff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices.

Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers’ diffusion of innovation theory

BackgroundCaregivers FIRST is an evidence-based program addressing gaps in caregivers’ skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST.MethodsIn a cohort observational study, we surveyed CSP managers about their facilities’ readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs “adopters” defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not (“non-adopters”). Within “adopters,” we categorized time to adoption based on Rogers’ diffusion of innovation theory including “innovators,” “early adopters,” “early majority,” “late adopters,” and “laggards.” Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between “adopters,” “non-adopters,” and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among “adopters.”ResultsFifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for “adopters” and “non-adopters.” However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the “adopters.” Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11–5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12–6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an “innovator,” “early adopter”, or “early majority”). Site-level characteristics were not associated with Caregivers FIRST early adoption.ConclusionsTo our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption.Trial registrationClinicalTrials.gov, NCT03474380. Registered on March 22, 2018

Considerations for Implementing the Post-Concussion Collegiate Return-to-Learn Protocol in the National Collegiate Athletic Association Power 5 Conferences.

Although concussions affect millions of young adults annually, researchers have yet to assess factors that may affect future implementation of post-concussion academic supports within higher education. Therefore, we sought to evaluate preimplementation outcomes of the acceptability, feasibility, appropriateness, and readiness for change of the Post-Concussion Collegiate Return-to-Learn (RTL) Protocol among university stakeholders. An online survey. A convenience sample ( N = 49; 63.3% female) of athletic trainers (ATs; n = 25, age = 30.1 ± 7.6 years) and university faculty/staff ( n = 24, age = 38.3 ± 9.9 years) across the National Collegiate Athletic Association (NCAA) Power 5 Conferences from January to February 2022. A cross-sectional study. To compare preimplementation outcome measures using the Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), Intervention Appropriateness Measure (IAM), and Organizational Readiness for Implementing Change (ORIC) regarding the RTL protocol between ATs and university faculty/staff. Additional outcomes included internal and external barriers to implementing at their respective institutions. Statistical analyses were conducted using Mann-Whitney U tests, with effect sizes estimated using eta-squared coefficient (η 2 ). Quantitative analyses yielded no statistically significant group differences ( P s > .05) across the AIM, FIM, and IAM outcomes, indicating both groups perceived the protocol to be acceptable, feasible, and appropriate. Moreover, ATs reported higher agreement regarding motivation, desire, willingness to do "whatever it takes," commitment, and determination to implement the novel protocol than faculty/staff. Further, ATs reported higher agreement regarding their institution's confidence to keep track of its progress, support adjustment, maintain momentum, manage institutional politics, coordinate tasks, encourage investment, and handle the challenges of future implementation of the RTL protocol. Preliminary findings suggest ATs and university faculty/staff across the NCAA Power 5 Conferences may perceive the RTL protocol to be acceptable, feasible, and appropriate for future use; however, noteworthy internal and external barriers may influence its uptake. Future research should utilize implementation frameworks to support the protocol's adoption and reach.

Readying Community Pharmacies to Participate in COVID-19 Testing and Vaccination.

Washington State established a Memorandum of Understanding (MOU) and operational plan in 2012 to coordinate pharmacy infrastructure and workforce during a public health emergency. The objectives of this study were to adapt the MOU operational plan to the context of the coronavirus disease 2019 (COVID-19) pandemic and assess community pharmacies' organizational readiness to implement COVID-19 testing and vaccination. This mixed methods study was conducted June-August 2020. Three facilitated discussions were conducted with community pharmacists and local health jurisdiction (LHJ) representatives to test the MOU operational plan. Facilitated discussions were thematically analyzed to inform adaptations to the operational plan. Pharmacists were surveyed to assess their organization's readiness for COVID-19 testing and vaccination before and after the facilitated discussions using the Organizational Readiness for Implementing Change (ORIC) measure. Survey responses were analyzed using descriptive statistics. Six pharmacists from 5 community pharmacy organizations and 4 representatives from 2 LHJs participated in at least 1 facilitated discussion. Facilitated discussions resulted in 3 themes and 16 adaptations to the operational plan. Five of 6 community pharmacists (83% response rate) completed both surveys. Mean organizational readiness decreased from baseline to follow-up for COVID-19 testing and vaccination. Operational plan adaptations highlight opportunities to strengthen MOUs between local and state health departments and community pharmacies to support future emergency preparedness and readiness efforts.

Leveraging the Multidisciplinary Tumor Board for Dissemination of Evidence-Based Recommendations on the Staging and Treatment of Gastric Cancer: A Pilot Study

BackgroundCompliance with evidence-based treatment guidelines for gastric cancer across the United States is poor. This pilot study aimed to create and evaluate a change package for disseminating information on the staging and treatment of gastric cancer during multidisciplinary tumor boards and for identifying barriers to implementation.MethodsThe change package included a 10-min video, a brief knowledge assessment, and a discussion guide. Commission on Cancer-accredited sites that perform gastrectomy were invited to participate. Participants completed the Organizational Readiness for Implementing Change (ORIC) scale (range, 12–60) and scales to measure the feasibility, acceptability, and appropriateness (score range, 4–20). Semi-structured interviews were conducted to further define inner and outer setting barriers.ResultsSeven centers participated in the study. A total of 74 participants completed the pre-video knowledge assessment, and 55 participants completed the post-video assessment. The recommendations found to be most controversial were separate staging laparoscopy and modified D2 lymphadenectomy. Sum scores were calculated for acceptability (mean, 17.43 ± 2.51) appropriateness (mean, 16.86 ± 3.24), and feasibility (mean, 16.14 ± 3.07) of the change package. The ORIC scores (mean, 46.57 ± 8.22) correlated with responses to the open-ended questions. The key barriers identified were patient volume, skills in the procedures, and attitudes and beliefs.ConclusionsThe change package was moderately to highly feasible, appropriate, and acceptable. The activity identified specific recommendations for gastric cancer care that are considered controversial and local barriers to implementation. Future efforts could focus on building skills and knowledge as well as the more difficult issue of attitudes and beliefs.

Using tele-mentoring to optimize quality of care and quality of life for patients with renal cell carcinoma (TOQQ-RCC).

326 Background: Overall survival from metastatic renal cell carcinoma (RCC) has risen in recent years due in part due to therapies such as immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI). TKI and ICI have unique and high-impact side effect profiles, and deficits persist in clinicians’ understanding of patient tolerance of and response to treatment, particularly in rural and community practices. We developed a tele-mentoring series to improve knowledge and clinical care gaps in ICI and TKI toxicity assessment and management for persons treated for RCC. Methods: Rural and community cancer care teams were invited by the Masonic Cancer Alliance, the outreach network of The University of Kansas Cancer Center, to participate in a five session Project ECHO (Extension for Community Health Outcomes) didactic and case-based educational series. Topics included distress screening, shared decision-making for RCC treatment, ICI and TKI toxicity assessment and management, at-home ICI administration, and implementing toxicity monitoring protocols. A mixed-methods approach collected data from participants pre- and post-TOQQ-RCC series. Clinician interviews assessed current practice protocols and were transcribed and analyzed thematically. Organizational Readiness for Implementing Change (ORIC) was administered pre- and post-TOQQ-RCC intervention; mean scores were calculated to determine readiness for change in toxicity monitoring and management protocols. Participant engagement and satisfaction were assessed; satisfaction measure included a Likert-like scale of poor, fair, average, good, and outstanding. Results: Fifty-two attendees from 11 cancer care institutions across Kansas and Missouri registered for the TOQQ-RCC sessions. An average of 15 participants attended each session including physicians, advanced practice providers, nurses, and other disciplines. Session evaluations rated content/delivery as good or outstanding. Themes from qualitative analysis revealed patient education as a primary barrier to effective toxicity identification and management. One-third of participants completed ORIC post-assessment; mean ORIC scores dropped by a mean 0.4 (10%) post-TOQQ-RCC series, indicating decreased readiness to implement changes to toxicity monitoring and management protocols. Conclusions: Rural and community oncology clinicians are willing to engage in tele-mentoring to improve knowledge and clinical care gaps regarding ICI and TKI toxicity assessment and management. Decrease in ORIC scores post-TOQQ-RCC series may indicate increased understanding of the complex processes and resources required to institute meaningful improvement to toxicity monitoring and management protocols for patients treated in rural and community settings. Future directions will include formal organizational needs assessments.

Mapping the current state of pediatric surgical pain care across Canada and assessing readiness for change

ABSTRACT Background Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery. Aims The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada. Methods An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%–79.8% reported “yes, for every child”), with tertiary/quaternary children’s hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants “somewhat agreed” that their institutions were committed and capable of change in pediatric surgical pain care. Conclusions There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain.

Integrating PrEP delivery in public health family planning clinics: a protocol for a pragmatic stepped wedge cluster randomized trial in Kenya

BackgroundAdolescent girls and young women account for a disproportionate fraction of new HIV infections in Africa and are a priority population for HIV prevention, including provision of pre-exposure prophylaxis (PrEP). Anchoring PrEP delivery to care settings like family planning (FP) services that women already access routinely may offer an efficient platform to reach HIV at-risk women. However, context-specific implementation science evaluation is needed.MethodsThe Family Planning Plus Project is a prospective, pragmatic implementation evaluation, designed as a stepped wedge, cluster randomized trial, at 12 clinics in Kenya. In collaboration with the Kenya Ministry of Health and Kisumu County Department of Health, we will introduce integration of HIV risk screening and PrEP delivery in public health FP clinics. The core multifaceted implementation strategies to integrate PrEP in FP clinics will include: (1) PrEP delivery by existing FP clinic staff, (2) health provider training, (3) PrEP technical assistance to coach and mentor providers, (4) joint supervision with Kisumu County health officials, and (5) stakeholder engagement. All core components of PrEP delivery—including screening for HIV risk, HIV testing, dispensing, adherence and risk reduction counseling, assessment of side effects, and provision of refills, or safety assessment—will be conducted by existing FP clinic staff as part of a standard care service package. The goal is to catalyze sustainable scale-up within existing infrastructures beyond the project. We will rigorously evaluate implementation outcomes and impact, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, and we will use Organizational Readiness for Implementing Change (ORIC) and the Consolidated Framework for Implementation Science Research (CFIR) to assess readiness to implement and contextual enablers and barriers of implementation, including how clinics innovate efficient delivery systems.DiscussionAnchoring PrEP delivery to existing FP systems and staffing has tremendous potential to address barriers that women face in accessing HIV prevention and PrEP care, including lack of time, cost, and stigma of visiting a facility solely for HIV prevention. The FP Plus Project will initiate preparation for full-scale and sustainable model of integration of comprehensive HIV prevention services, including PrEP implementation, in public health FP clinics in low-income settings.Trial registrationRegistered with ClinicalTrials.gov on December 14, 2020: NCT04666792

Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers.

Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were participating in a tobacco-free workplace program. The number of total annual patient visits, unique annual patient visits, number of full-time employees, and organizational readiness for implementing change (ORIC) as assessed prior to implementation were examined as potential moderators. Results demonstrated significant knowledge gain (p < 0.001) after training overall; individually, 13 SUTCs had significant knowledge gain (p’s < 0.014). SUTCs with fewer total annual patient visits and fewer full-time employees showed greater knowledge gains. The ORIC total score and all but one of its subscales (Resource Availability) moderated knowledge gain. SUTCs with greater initial Change Efficacy (p = 0.029), Valence (p = 0.027), and Commitment (p < 0.001) had greater knowledge gain than SUTCs with lower scores on these constructs; SUTCs with greater Task Knowledge (p < 0.001) regarding requirements for change exhibited less knowledge gain. Understanding the organizational-level factors impacting training effectiveness can inform efforts in organizational change and tobacco control program implementation.

Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia

BackgroundThe sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.MethodsA descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant’s commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.ResultsOverall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12–60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, “People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements “People who work here are determined to implement this change”, “People who work here want to implement this change”, and “People who work here are committed to implementing this change.ConclusionResults of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.

Organizational Readiness for Lung Cancer Screening: A Cross-Sectional Evaluation at a Veterans Affairs Medical Center.

Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. We evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening. We performed a cross-sectional survey of providers, staff, and administrators in radiology and primary care at a single Veterans Affairs Medical Center. Survey measures included Shea's validated Organizational Readiness for Implementing Change (ORIC) scale and Shea's 10 items to assess change valence. ORIC and change valence were scored on a scale from 1 to 7 (higher scores representing higher readiness for change or valence). Multivariable linear regressions were conducted to determine predictors of ORIC and change valence. Of 523 employees contacted, 282 completed survey items (53.9% overall response rate). Higher ORIC scores were associated with radiology versus primary care (mean 5.48, SD 1.42 versus 5.07, SD 1.22, β= 0.37, P= .039). Self-identified leaders in lung cancer screening had both higher ORIC (5.56, SD 1.39 versus 5.11, SD 1.26, β= 0.43, P= .050) and change valence scores (5.89, SD 1.21 versus 5.36, SD 1.19, β= 0.51, P= .012). Radiology health professionals have higher levels of readiness for change for implementation of LDCT screening than those in primary care. Understanding health professionals' behavioral determinants for change can inform future lung cancer screening implementation strategies.

What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP).

Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.

Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician's Delivery of Smoking Interventions within Behavioral Health Treatment Clinics.

BackgroundSmoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation. MethodsLMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N = 1237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects. ResultsClinician delivery of 5As increased pre- to post-implementation (p < .001). LMHAs with fewer employees (ref = ≤300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref = ≤10 000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps < .025).ConclusionThe smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building training and resources are provided.ImplicationsThis study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 LMHAs across Texas (hundreds of clinics; servicing >50% of the state) from 2013 to 2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.

Adaptação transcultural e propriedades psicométricas da versão em português (Brasil) do questionário Prontidão Organizacional para Implementação de Mudança para implementação de mudança em serviços de saúde

The assessment of the degree to which health professionals, workers and organizations are ready to implement changes in health services deserves special attention, especially related to new technologies, public policies and innovation. The objectives of this study were to conduct a Brazilian Portuguese Brazil cross-cultural adaptation of the ORIC questionnaire and to initiate the study of its psychometric properties. Through a cross-sectional study, the Organizational Readiness for Implementing Change (ORIC) questionnaire, containing 12 questions, was translated and later applied to a sample of workers from traditional primary health care units undergoing transformation to family health units. Statistical analysis included Cronbach's alpha, exploratory and confirmatory factor analysis by structural equation model using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Workers from ten health units participated in the study (n = 150). The analysis confirmed two main factors (Effectiveness and Commitment) with Eigenvalues > 1. Rotation by the orthogonal method showed that the instrument questions confirmed the factors analyzed by the original instrument. The total Cronbach's Alpha of ORIC was 0.94, showing excellent reliability. The Brazilian Portuguese Brazil version of the ORIC-Br questionnaire showed good psychometric properties and can be used in health services to measure organizational readiness, considered as an indicator of the potential success in implementing change.

French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC)

BackgroundOrganizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner’s organizational theory, the “Organizational Readiness for Implementing Change” (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties.Methods(1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach’s alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis.ResultsA French 10-item scale named the Réceptivité organisationnelle à l’implantation d’un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach’s alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC’s items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC’s model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12).ConclusionsThe ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.

Exploring Nunavut Public Health System's Readiness to Implement Obesity Prevention Policies and Programs in the Canadian Arctic.

Background Rapid changes in the food and built environments in the Canadian Arctic have contributed to a dramatic increase in the prevalence rates of obesity. The objective of this study was to explore the determinants of Nunavut public health system's commitment to implement obesity prevention policies and programs in the territory to reduce the burden of obesity-related diseases. Methods In total, 93 program managers, program officers, and policy analysts who are responsible for program and policy development and implementation within the Nunavut Department of Health (NDH) were asked to complete the validated Organizational Readiness for Implementing Change (ORIC) questionnaire. Organization-level readiness (commitment) was determined based on aggregated individual-level data using bivariate correlations and multivariate linear regression analyses. Results Of the 93 questionnaires that were distributed only 67 (72%) were returned fully completed. Organization-level commitment to implement obesity prevention policies and programs was low. Only 2.9% of respondents strongly agreed that NDH was committed to implementing obesity prevention policies and programs. The study showed a strong positive correlation between NDH's commitment and perceived value (r = .73), perceived efficacy (r = .50), and resource availability (r = .25). There was no correlation between commitment and knowledge. In the multivariate linear regression model, perceived value was the only significant predictor of NDH's commitment to implement obesity prevention policies and programs (β = 0.66). Conclusions Successful adoption and implementation of obesity prevention policies and programs in the Canadian Arctic largely depend on the perception of value and benefits of and belief in the change efforts among employees of the Nunavut Department of Health. Convincing policy makers of the value of preventive policies and programs is an important and necessary first step towards decreasing the prevalence of obesity in the Inuit population.