Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

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.

Facilitators, Barriers and Management Competencies Associated with Schools' Readiness to Implement New Accountable Practices

“…As mentioned above, ORC refers to organizational members' shared resolve to implement a change and their collective ability to do so; respectively, these dimensions are known as change commitment and change efficacy [9,23]. In practical terms, readiness for change requires both willingness and a capability to change [11].…”

“…Weiner uses the concept Change Valence to measure organizational members' perceptions of the proposed change that is if this change meets a need, if there are interests to be gained either for them or for the organization. [23]. Drawing on the work of many authors, Jones, Jimmieson and Griffiths [24] define this value as the extent to which employees perceive positively the need for the company to change (i.e.…”

“…However, he stresses that individual motivations to engage in the implementation of a change is less important than the level with which the members of the organization collectively value a change project. For their part, Shaw et al [23] identify perception of effectiveness and cost effectiveness while Bosworth et al [25] add a fit with the organizations' mission, goals and values and a perceived increase in job satisfaction as other factors that are associated with change valence.…”

“…A second category of ORC determinants is regrouped under the concept of Informational Assessment [9,23]. Determinants of this second dimension are based on the members' assessment of the information they possess regarding three aspects of a change project: knowledge about how the proposed change will have an impact on their tasks (task demands); perception of the resources (e.g., people, competencies, money, equipment, space, IT support) presently available and eventually needed to realize it (resources perceptions); and other situational factors such as time necessary to implement this change and it's timing, it's link and coherence with actual structures and actions currently under way, management support, and internal power dynamics generated by the nature and type of change to implement.…”

Organizational readiness for advanced manufacturing technology implementation by Malaysian manufacturing SMEs

“…In a study conducted by Shaw et al (2013) that examine the organizational readiness for change in implementing intervention for improving blood pressure control. Hypertension Telemedicine Nurse Implementation Project for Veterans was implement previous but resulting unclear in term of effectiveness.…”