Linkage between theory‐based measurement of organizational readiness for change and lessons learned conducting quality improvement–focused research

Abstract

Organizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) isan example of an innovation that seeks to enhance delivery of care for patients with hypertension. We describe the link between organizational readiness for change (ORC), assessed as the project began, and barriers and facilitators occurring during the process of implementing a primary care innovation. Each of 3 Veterans Affairs medical centers provided a half-time nurse and implemented a nurse-delivered, telephone-based self-management support program for patients with uncontrolled hypertension. As the program was starting, we assessed the ORC and factors associated with ORC. On the basis of consensus of medical center and research partners, we enumerated implementation process barriers and facilitators. The primary ORC barrier was unclear long-term commitment of nursing to provide continued resources to the program.Three related barriers included the need to address: (1) competing organizational demands, (2) differing mechanisms to integrate new interventions into existing workload, and (3) methods for referring patients to disease and self-management support programs. Prior to full implementation, however, stakeholders identified a high level of commitment to conduct nurse-delivered interventions fully using their skills. There was also a significant commitment from the core implementation team and a desire to improve patient outcomes. These facilitators were observed during the implementation of HTN-IMPROVE. As demonstrated by the link between barriers to and facilitators of implementation anticipated though the evaluation of ORC and what was actually observed during the process of implementation, this project demonstrates the practical utility of assessing ORC prior to embarking on the implementation of significant new clinical innovations. KEYWORDSdelivery of health care, health services research, hypertension, organizational innovationThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

“…In addition, most teams sustained their practice, unless they were not able to maintain necessary staffing or resources. Two CFIR constructs, Engaging Key Stakeholders and Available Resources, were key for both initial implementation success and sustainment, which is similar to factors noted in prior literature on programs both within and outside the VHA [37,38]. Other CFIR constructs did not have a major influence on implementation and sustainment outcomes due to the high level of implementation support provided, which helped teams overcome most barriers.…”

The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system

“…Organizational culture is important in facilitating and/or slowing the implementation and evolution of an LHS. Successful LHSs make the continuous cycle of improvement an integral part of their organizational culture, 11 , 13 , 17 not just an episodic and haphazardly applied philosophy.…”

“…The implementation of learning health systems (LHSs) is an area of strong interest for healthcare organizations, policymakers, and the public. 1 , 2 , 3 To date, however, many LHS efforts have been developed within single organizations, 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 not as collaborations among separate entities. Given the need to develop collaborative LHSs that are healthcare market‐centric, as opposed to organization‐centric, two questions are particularly relevant: (a) What are promising approaches to operationalizing an LHS across a regional healthcare market that spans different organizations?…”

“…LHS initiatives can be, roughly, grouped into three categories with regard to their scope: (a) single organization, (b) trans‐organizational, and (c) multi‐organizational/healthcare market‐focused: Single‐organization LHSs commonly make the LHS approach a key strategic and operational philosophy driven by top‐down priorities. Examples include the national health systems of Switzerland 14 and Denmark, 15 the Veterans Health Administration (VHA), 3 , 4 , 5 , 13 or multi‐site and single healthcare organizations such as Kaiser Permanente, 6 , 7 the Geisinger Health System, 8 and others. 9 , 10 , 11 , 12 While a common organizational foundation can promote the development of LHS approaches, significant cultural, and scalability challenges can impede their dissemination throughout all levels and sites.…”

“…Examples include the national health systems of Switzerland 14 and Denmark, 15 the Veterans Health Administration (VHA), [3][4][5]13 or multi-site and single healthcare organizations such as Kaiser Permanente, 6,7 the Geisinger Health System, 8 and others. [9][10][11][12] While a common organizational foundation can promote the development of LHS approaches, significant cultural, and scalability challenges can impede their dissemination throughout all levels and sites.…”