Abstract
Background/Aims Healthcare organizations are implementing an array of changes to provide more affordable, high quality care. Many organizations achieve only partial success when implementing improvement initiatives, with half of all failures due to a lack of readiness to change among personnel. This study examines factors that contribute to change readiness among employees in an organization undergoing system-wide transformation.
Methods Baseline data were collected from 706 physicians and staff in 19 primary care departments and 3 call centers in a large ambulatory care system. A validated, multi-dimensional Organizational Change Recipients’ Beliefs Scale was used to assess readiness to change. Multivariate regression was used to examine predictors of change readiness among physicians and non-physician personnel.
Results Non-physicians (nurses, medical assistants, administrative staff) reporting a high level of engagement (e.g., “My ideas and suggestions are valued by my department”) and ownership (e.g., “I am willing to put in a great deal of effort to help my department succeed”) scored significantly high on four dimensions of readiness to change, including perceived appropriateness of the change, anticipated benefit from changes, perceived support for change among peers and leaders, and capability to implement changes (P <0.01). Among physicians, commitment was positively associated with these four dimensions as well as a fifth dimension of readiness -- perceived need for change. Both physicians and non-physicians reporting burnout in the form of emotional exhaustion perceived greater need for change (P <0.01), while those with longer tenure in their department perceived less need for change (P <0.01). Burnout among non-physicians in the form of depersonalizing patients was associated with less perceived capability of implementing changes (P <0.05). Last, participation in decision-making within departments was positively associated with non-physician engagement and ownership (P <0.05).
Conclusions Perceptions about work environment can affect employees’ beliefs about changes being undertaken by their organization. Both employee engagement and ownership were instrumental in preparing non-physicians for change; only ownership affected physicians’ readiness to change. Burnout and tenure universally affected a perceived need for change. Encouraging staff participation in decision-making can help instill a sense of engagement and ownership among non-physicians, though alternative mechanisms must be sought for preparing physicians for change.
