Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States

Abstract

BackgroundDental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment.MethodsA dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy.ResultsProviders and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company’s mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0.45 and 0.8-unit increases in change commitment and change efficacy.ConclusionsThe survey identified positive readiness for change and highlighted weaknesses that are important cautions for this organization and others initiating change. Future studies will examine how organizational readiness to change, workforce characteristics and work environment influenced successful implementation within this organization.Electronic supplementary materialThe online version of this article (10.1186/s12903-017-0448-4) contains supplementary material, which is available to authorized users.

Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization

“…The structure and support facilitated by good organizational functioning (including, as in this study, positive organizational climate and quality management) may equip employees with change commitment and efficacy. The finding that perceived quality of management was the only significant predictor of organizational readiness for change in this sample differs from results of a similar study that we completed with another dental care organization, which serves a low-income population in largely rural communities in the state of Oregon (Cunha-Cruz et al 2017). That organization is large, complex, and privately held, with both fixed clinics and mobile care-much of which is in primary schools-and employs expanded practice dental hygienists and outreach workers.…”

“…Theoretically, readiness is considered to be a function of contextual factors (e.g., culture, resources, structure) and to encompass both change efficacy (i.e., the perceived capability for change) and change commitment (i.e., steadfast engagement with whatever may be required to attain change; Weiner 2009). High organizational readiness for change has been associated with successful implementation of new initiatives across multiple health care disciplines (e.g., Caldwell et al 2009;Pare et al 2011;Hannon et al 2017); however, very few studies (Reynolds et al 2016;Cunha-Cruz et al 2017) have assessed the role of this important construct in dentistry and dental care organizations. Changes in care delivery systems are occurring in dentistry at greater frequency and at faster pace than before, including an increasing number of providers working in large group practices (Vujicic 2017).…”

Job (dis-)satisfaction in pay-for-performance health care contexts: a meta-synthesis of qualitative literature

“…Arvidsson et al. , 2021), studies show that a compensation package that adds additional tangibles (benefits, welfare, other monetary rewards) to fixed pay generates a higher level of satisfaction in general and occupational well-being in particular (Cunha-Cruz et al. , 2017; Rasi et al.…”

“…Moreover, in the face of a general situation of average worker dissatisfaction with the work (e.g. Arvidsson et al, 2021), studies show that a compensation package that adds additional tangibles (benefits, welfare, other monetary rewards) to fixed pay generates a higher level of satisfaction in general and occupational well-being in particular (Cunha-Cruz et al, 2017;Rasi et al, 2018). In fact, workers seem to be aware that monetary rewards have a decisive weight in their perception of occupational well-being.…”

Issues and Implications of Readiness to Change

“…Managers have an essential role in meeting the variations head-on to enhance conformity to the new environments. Organizational change is a constant process that significantly affects the efficiency of the organization (Cunha-Cruz et al 2017). Therefore, it is essential to pay attention to different change alerts from within and outside the organization.…”