Ready, set, go!: exploring use of a readiness process to implement pharmacy services

Abstract

Background Readiness is an essential precursor of successful implementation; however, its conceptualization and application has proved elusive. R = MC 2 operationalizes readiness for use in practice. The purpose of this study was to (1) describe the application of R = MC 2 to assess and build readiness in nine healthcare sites responsible for implementing medication management services and (2) gain insights into the sites’ experience. Methods This mixed methods exploratory study used data collected as part of a process evaluation. Understanding application of the readiness process (Aim 1) involved examining team members’ involvement (who?), readiness challenges and readiness building strategies (what?), strategy execution (how much?), and resulting changes (for what purpose?). To understand the sites’ experience with the R = MC 2 system (Aim 2), interviews were conducted with six of the sites to identify facilitators, barriers, and lessons learned. Data sources included a document review (e.g., sites’ action plans), survey results, and interview data. Results Sites included primary care and specialty clinics, pharmacies within health systems, and community pharmacies. Teams consisted of 4–11 members, including a lead pharmacist. The teams’ readiness activities clustered into five broad categories of readiness building strategies (e.g., building the operational infrastructure for service integration). Of the 34 strategies identified across sites, 68% were still in progress after 4 months. Engaging in the readiness process resulted in a number of outputs (e.g., data management systems) and benefits (e.g., an opportunity to ensure alignment of priorities and fit of the intervention). Based on the interviews, facilitators of the readiness process included assistance from a coach, internal support, and access to the readiness tools. Competing priorities and lack of resources, timely decision-making, and the timing of the readiness process were cited as barriers. The importance of service fit, stakeholder engagement, access to a structured approach, and rightsizing the readiness process emerged as lessons learned. Conclusions These findings provide valuable insights into the application of a readiness process. If readiness is to be integrated into routine practice as part of any implementation effort, it is critical to gain a better understanding of its application and value.

The Readiness, Resilience and Recovery Tool: An Emerging Approach to Enhance Readiness Amidst Disruption

“…The process is relatively sequential and utilizes a strong research base for the assessment and change management strategies for readiness, pulling from cross-disciplinary literature (e.g., Kotter, 2012 ; Langley et al, 2009 ; Powell et al, 2012 ). It works for implementations that are experiencing normal conditions and routine challenges (Livet et al, 2020 ). However, when there is a significant disruption or disruptions, the changes are v olatile, u ncertain, c omplex, and a mbiguous or VUCA.…”

“…Readiness is a critical aspect of successful implementation (Livet et al, 2020 ). R = MC 2 defines readiness as the interplay between m otivation, innovation-specific c apacity and general c apacity.…”

“…By assessing readiness, establishing priorities for readiness improvement, and selecting and implementing evidence-based readiness change strategies, readiness can be improved. Ultimately, engaging in a readiness building process and utilizing targeted readiness building strategies to enhance certain capacities and motivation can help to achieve outcomes (Livet et al, 2020 ). Additionally, building readiness can be closely linked to many implementation outcomes such as acceptability, appropriateness and feasibility (Proctor et al, 2011 ).…”

School Coordinators’ Perceptions of Organizational Readiness Is Associated with Implementation Fidelity in a Smoking Prevention Program: Findings from the X:IT II Study

“…Organizational readiness to implement refers to the extent to which an organization is both willing and able to implement a new initiative (Scaccia et al 2015). There is no consensus about the conceptualization and measurement of organizational readiness (Miake-Lye et al 2020, Livet et al 2019, Weiner et al 2020. Traditionally, most scholars have viewed readiness as a psychological construct; however, recently, Scaccia et al (2015) have proposed that readiness consists of both psychological and structural dimensions (Weiner et al 2020).…”

R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings

“…Rather than viewing an organization as "ready" or "not ready," the R = MC 2 approach assesses an organization's degree of readiness for implementation ranging from lower to higher levels of readiness (Scaccia et al, 2015;Scott et al, 2017). Lastly, readiness subcomponents can be improved through active supports (e.g., training, technical assistance, quality monitoring; Livet et al, 2020;Scaccia et al, 2018). Despite evidence that readiness building strategies can effectively improve implementation outcomes (Ober et al, 2017), systematic processes for building the readiness of a setting for implementation are underdeveloped.…”