November 1, 2017 Isomi Miake-Lye, PhD VA Greater Los Angeles Healthcare System “Unpacking Organizational Readiness for Change: Mapping Organizational Readiness Assessments to an Implementation Framework” A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series Provided by the UCLA CTSI

1. Unpacking Organizational
Readiness for Change
Mapping Organizational Readiness
Assessments to an Implementation Framework
Isomi Miake-Lye, PhD1,2, David Ganz, MD1,2,
Brian Mittman, PhD1,3, Deborah Delevan1 and Erin Finley,
PhD4,5
(1) VA Greater Los Angeles Healthcare System; (2) University of
California, Los Angeles; (3) Kaiser Permanente Southern California;
(4)The University of Texas Health Science Center at San Antonio; (5)
South Texas Veterans Health Care System

2. BACKGROUND

3. Improving Patient-Centered Care Coordination for High-Risk Veterans in PACT

4. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Care Coordination QUERI

5. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Improving information
flow from emergency
department to primary
care
Care Coordination QUERI

6. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Improving information
flow from emergency
department to primary
care
Care Coordination QUERI
Improving coordination
for primary care and
outpatient services

7. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Improving information
flow from emergency
department to primary
care
Care Coordination QUERI
Improving coordination
for primary care and
outpatient services
Improving post-
discharge coordination
with community-
enhanced care

8. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Improving information
flow from emergency
department to primary
care
Care Coordination QUERI
Improving coordination
for primary care and
outpatient services
Improving post-
discharge coordination
with community-
enhanced care

9. Organizational Readiness Assessments
A Goldilocks Problem
• Our projects wanted to:
– Select sites/use as diagnostic
– Tailor
intervention/implementation
– Explain outcomes and
implementation success
• Emphasis on:
– Parsimony
– Practicality

10. Readiness
Assessments
Organizational Readiness Assessments
A Goldilocks Problem
• Our projects wanted to:
– Select sites/use as diagnostic
– Tailor
intervention/implementation
– Explain outcomes and
implementation success
• Emphasis on:
– Parsimony
– Practicality

11. Readiness
Assessments
Organizational Readiness Assessments
A Goldilocks Problem
TOO LONG
• Our projects wanted to:
– Select sites/use as diagnostic
– Tailor
intervention/implementation
– Explain outcomes and
implementation success
• Emphasis on:
– Parsimony
– Practicality

12. Readiness
Assessments
Organizational Readiness Assessments
A Goldilocks Problem
TOO LONG
TOO NARROW
• Our projects wanted to:
– Select sites/use as diagnostic
– Tailor
intervention/implementation
– Explain outcomes and
implementation success
• Emphasis on:
– Parsimony
– Practicality

13. OBJECTIVES

14. What are core components of
organizational readiness for change
to measure to get
best implementation outcomes?

15. capability
The extent to which organizational
members are psychologically and
behaviorally prepared to implement
organizational change
collective
motivation efficacy
multilevel
Readiness Defined
A comprehensive attitude influenced
simultaneously by the nature of the
change, the change process, the
organization’s context and the attributes
of individuals
Holt
Weiner

16. Mapping Method
Identifying a Rosetta Stone
Readiness
Assessments CFIR

17. V.
Process
CFIR Domains
Consolidated Framework For Implementation Research
I. Intervention
Characteristics
IV. Characteristics
of Individuals
III. Inner setting
II. Outer setting
Damschroder, Laura J., et al. Implementation science 2009

18. CFIR
Domains +
Constructs

19. CFIR
Domains +
Constructs

20. CFIR Subconstructs
Process

21. CFIR Subconstructs
Inner Setting

22. METHODS

23. Searches
• Started from a 2014
systematic review*
• Conducted an update
search
• Additional relevant
references
Screening Criteria
• Deployed in a healthcare
delivery setting
• Measured organizational
readiness
• Provided actual assessment
used
Identification and Screening
*Gagnon, Marie-Pierre, et al. PloS one 9.12 (2014): e114338

24. Mapping Method
Data abstraction
?
? ?
?
? ?
?
? ?
?
? ?
?
? ?

25. 1,236 items from
assessments
collated into
database
Mapping Method
Data abstraction
?
? ?
?
? ?
?
? ?
?
? ?
?
? ?
??????
??????
??????

26. Independent dual
review of each item
1,236 items from
assessments
collated into
database
Mapping Method
Data abstraction
?
? ?
?
? ?
?
? ?
?
? ?
?
? ?
??????
??????
??????
• Tool of origin
• CFIR construct
• Unit of measurement
• Specific to intervention
• Etc
?

27. RESULTS

28. Readiness Assessments Identified
Individual items (n=1,236)

29. Readiness Assessments Identified
Individual items (n=1,236)

30. Readiness Assessments Identified
Individual items (n=1,236)

31. Readiness Assessments Identified
Individual items (n=1,236)

32. Readiness Assessments Identified
Individual items (n=1,236)

33. Items
mapped to
CFIR

34. Items
mapped to
CFIR

35. Top CFIR
Constructs

36. Top CFIR
Constructs

37. “Tangible and immediate
indicators of organizational
change.”
Readiness for Implementation

38. Readiness for Implementation
This organization’s most
senior leader is committed
to changes related to the
move to the new hospital
PPOE

39. Readiness for Implementation
Our senior leaders have
encouraged all of us to
embrace changes related
to the move to the new
hospital
People who work here feel
confident that the organization can
get people invested in
implementing this change.
PPOE
ORIC

40. Readiness for Implementation
Our senior leaders have
encouraged all of us to
embrace changes related
to the move to the new
hospital
(e.g., buy-in, prior experiences)
People who work here feel
confident that the organization can
get people invested in
implementing this change.
Financial resources for initial
and ongoing training are
adequate.
PPOE
ORIC
Cherry

41. “The absorptive capacity for
change, shared receptivity of
involved individuals to an
intervention and the extent to
which use of that intervention
will be rewarded, supported,
and expected within their
organization.”
Implementation Climate

42. Implementation Climate
My unit needs guidance in
developing services to
address alcohol and drug
behaviors presented by
our patients.
MORC

43. Implementation Climate
My unit needs guidance in
developing services to
address alcohol and drug
behaviors presented by
our patients.
Using e-health technology can
improve my efficiency.
SoOR
MORC

44. Implementation Climate
My unit needs guidance in
developing services to
address alcohol and drug
behaviors presented by
our patients.
Using e-health technology can
improve my efficiency.
I think we are spending a lot of time on
this change when the senior managers
don't even want it implemented.
Holt
SoOR
MORC

45. Top CFIR
Constructs

46. “The nature and quality of
webs of social networks and
the nature and quality of
formal and informal
communications within an
organization.”
Networks & Communications

47. Networks & Communications
Different parts of the
organization work together
well; when conflict arises,
it is often productive.
STSS

48. Networks & Communications
Different parts of the
organization work together
well; when conflict arises,
it is often productive.
I am clear about my responsibility in
the team.
Gibb
STSS

49. Networks & Communications
Different parts of the
organization work together
well; when conflict arises,
it is often productive.
I am clear about my responsibility in
the team.
I am encouraged here to try new and
different techniques.
MORC
Gibb
STSS

50. “A broad construct to include
other personal traits such as
tolerance of ambiguity,
intellectual ability, motivation,
values, competence, capacity,
and learning style.”
Other Personal Attributes

51. Other Personal Attributes
Clinical experience
is more important
than randomized
controlled trials.
PSS

52. Other Personal Attributes
Clinical experience
is more important
than randomized
controlled trials.
Other staff often
ask your advice
about program
procedures.
ORC-S; Guerrero
PSS

53. Other Personal Attributes
Clinical experience
is more important
than randomized
controlled trials.
Other staff often
ask your advice
about program
procedures.
Learning and using new
procedures are easy for me.
ORC-D/S; Guerrero
ORC-S; Guerrero
PSS

54. “The social architecture, age,
maturity, and size of an
organization.”
Structural Characteristics

55. Structural Characteristics
Our medical group has
well-developed
administrative structures
and processes in place to
create change.
Rubenstein

56. Structural Characteristics
Our medical group has
well-developed
administrative structures
and processes in place to
create change.
A larger support staff is needed to
help meet program needs
ORC-D/S; Guerrero
Rubenstein

57. Structural Characteristics
Our medical group has
well-developed
administrative structures
and processes in place to
create change.
A larger support staff is needed to
help meet program needs
More computers are needed in
this program for staff to use
ORC-D/S; Guerrero
ORC-D/S; Guerrero
Rubenstein

58. Assessment Size Over Time
Number of items per assessment by year
0
20
40
60
80
100
120
140
1985 1990 1995 2000 2005 2010 2015 2020
NumberofItemsinassessment
Year
ORC Melnyk Holt Other

59. Constructs over Time
Number constructs per Assessment by Year
0
2
4
6
8
10
12
14
1985 1990 1995 2000 2005 2010 2015 2020
Numberofcostructsinassessment
Year
ORC Mel Holt Other

60. CONCLUSIONS

61. Readiness is…
• A multi-level problem
• Mostly captured within:
– Inner Setting
– Characteristics of Individuals
Popular Constructs
Summary of Findings

62. Do you
have what
you need
for X?
Are
people
into X?
Do people
work well
together?
Is X
wanted
and
needed?

63. Implications
• Assessments demonstrate need for tailoring to particular
projects/settings
• Relationships/team functioning are critical components of
organizational readiness, pervasive throughout items in
various constructs

64. Limitations
• “Little consistency in terminology or conceptualization”*
• Identifying all relevant literature without standardized search
terms (MeSH)
• Only published assessments included
– Counted by study, rather than assessment
*Weiner, et al. Med Care Res Rev 65.4 (2008):379-436

65. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Assessed during buy-in
process, currently
analyzing project
findings
Care Coordination QUERI
Organizational Readiness for Change

66. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Assessed during buy-in
process, currently
analyzing project
findings
Care Coordination QUERI
Organizational Readiness for Change
Semi-structured
interviews and survey
currently underway

67. ED-PACT
tool
Toolkit
and
Coaching
Implementation
Core
Hospital
to
Community
Assessed during buy-in
process, currently
analyzing project
findings
Care Coordination QUERI
Organizational Readiness for Change
Semi-structured
interviews and survey
currently underway Piloting/refining

68. THANK YOU
Funded by QUE 15-276: Improving Patient-Centered Care Coordination for
High-Risk Veterans in PACT (VA Care Coordination QUERI)
If you have further questions, feel free to contact:
isomi.miake-lye@va.gov

69. Readiness Assessments Identified
Individual items (n=1,236)

70. References
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referral to treatment." Journal of addiction medicine 2.3 (2008): 151-157.
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