Readiness as a precursor of early implementation outcomes: an exploratory study in specialty clinics

Abstract

Background Readiness has been identified as an essential precursor of successful implementation. However, evidence supporting its value is sparse. Empirical studies exploring the relationship between the application of readiness interventions, readiness levels, and implementation outcomes are lacking. The purpose of this study was twofold: (1) to evaluate the effectiveness of a readiness intervention (based on increases in readiness levels, changes in early implementation outcomes (i.e., acceptability, appropriateness, feasibility, and intent to adopt), and qualitative insights into the types of perceived outcomes) and (2) to assess the role of readiness as a predictor of these early implementation outcomes. Methods Seven healthcare specialty clinics engaged in a structured process to assess and build readiness for implementing a comprehensive medication management (CMM) service over a 10-month period. A mixed methods approach, which included surveys with healthcare stakeholders at each clinic (N = 27) and interviews with the lead pharmacists (N = 7), was used to evaluate the effectiveness of the readiness intervention (aim 1). Survey data were also used to conduct multiple regression models to assess the role of readiness as a predictor of early acceptability, appropriateness, feasibility, and intent to adopt CMM (aim 2). Results Significantly higher readiness levels, as well as higher scores on acceptability, appropriateness, feasibility, and intent to adopt, were reported as a result of engaging in the readiness intervention. However, upon closer examination, the direction of this association seemed to be dependent on the type of clinic. Qualitative data on the types of perceived outcomes resulting from engaging in the readiness intervention provided further insights into the potential reasons for these findings. Furthermore, post-readiness levels predicted between 44 and 68% of the variance in the early implementation outcomes. When accounting for clinic membership, readiness remained critical for service acceptability, feasibility, and intent to adopt but not for appropriateness. Conclusion These findings provide insights into the relationship between use of a readiness intervention, readiness levels, and early implementation outcomes. Engaging healthcare settings in a readiness intervention was beneficial in ways more complex than a simple positive linear relationship, highlighting the opportunity to broaden its purpose and expand definitions of readiness success. In addition, the importance of readiness levels in predicting early implementation outcomes, while critical, also seems to be highly dependent on context, particularly for appropriateness (fit).

Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia

“…Readiness assessments typically involve determining if health system members understand the tasks required to implement new policies or programmes, assessing availability of required resources, and identifying favourable conditions for implementation 34 35. High levels of readiness are associated with increased acceptability and intent to adopt new policies or programmes, resulting in more successful implementation 36 37. In our study, a readiness survey will identify the Ethiopian health system’s readiness and capacity to scale up the LAUNCH intervention and identify points of lower readiness, where additional support or change management might be needed prior to implementation of a scaled up LAUNCH intervention or other community-based programmes for newborn health.…”

Contextual factors in the implementation of the family support program A Healthy School Start in three municipalities in Sweden

“…The question can be raised if implementation be started at all if like in M2 at baseline 50% of participants scored in quadrant I "Low Acceptability and low Readiness" while only 26% of M2 scored in the quadrant "High acceptability and high readiness". Another study also found a high correlation between readiness and implementation outcomes and suggested that readiness is a precursor of early implementation outcomes like ACC, APP and FEAS and an essential step in the preimplementation process (11). These authors warned against implementing a service in an organization receiving a low appropriateness score without engaging in a process to improve readiness.…”

“…The concept of readiness has been shown to be highly correlated with early implementation outcomes like ACC, APP and FEAS, but there does not seem to be a simple linear relationship between these outcomes (11). While a program may be found acceptable by the stakeholders and appropriate for a given setting, it may not be feasible typically due to lack of resources or competence of providers.…”

Integrating comprehensive medication management in specialty clinics: A feasibility study

“…Of note, the implementation phase was shortened from 12 to 8 months due to the advent of the COVID-19 pandemic. Briefly, the planning phase (described elsewhere 15 ) aimed to increase implementation readiness through an evidence-informed systematic process involving participation in trainings, development of implementation teams, readiness assessments and action plans, and development of the needed implementation infrastructure for CMM (e.g., tailored CMM workflows).…”