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Table 1 Factors relating to achievement of a patient flow improvement – organizational change policy intervention

From: Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

 

Assessment Domains

 
 

Organizational Readiness

Predictive of successful implementation

Capacity to manage change

Mean

Change stage one: organizational goals & architecture

    

Please tell us to what extent your organizational leadership and/or organizational staff are concerned about ED-GIM (emergency department – general medicine) flow issues in your hospital:

7.7

6.7

5.4

6.6

ED-GIM flow issues in my hospital represent a critical challenge to our mission:

7.6

7.3

5.7

6.6

How high on your priority list would you place an initiative dealing with ED-GIM flow?

7.9

7.5

5.8

7.1

Is general internal medicine (GIM)/general medicine a core clinical priority for your hospital?

6.7

6

5.2

6.0

Change stage 2a: organizational readiness for change

    

Please tell us your previous experience with organizational change initiatives: How many MAJOR organizational change initiatives have taken place or have been planned in the past year (2008/2009).

6.1

5.8

5.2

5.7

Thinking about your hospital, what is the significance of: Staff burn-out from past change initiatives, as a potential barrier to improvements in ED flow and efficiency?

6.5

6.6

5.5

6.2

Thinking about your hospital, what is the significance of: Physician resistance to change, as a potential barrier to improvements in ED flow and efficiency?

7.3

7.7

6.6

7.2

Change stage 2b: situational analysis and redesign of organizational systems

    

Thinking about your hospital, what is the significance of: Current communication practices between physician leadership and front-line nursing management, as a potential barrier to improvements in ED flow and efficiency?

6.4

6.8

5.4

6.2

Thinking about your hospital, what is the significance of: Current lack of coordination between ER and internal medicine on bed management issues, as a potential barrier to improvements in ED flow and efficiency?

6.9

7.2

5.7

6.6

Thinking about your hospital, what is the significance of: Current lack of physician coverage in the ED, as a potential barrier to improvements in ED flow and efficiency?

6.5

6.3

5.5

6.1

Change stage 3: capacity to build coalitions, broaden support and align systems

    

Considering previous change initiatives your hospital has undertaken, were you able to develop effective communication methods, systems and strategies within and between medical/clinical services and sub-specialists within your hospital?

6.3

6.5

5.9

6.2

Thinking about your hospital, what is the significance of: misalignment between physician incentives and goal of patient flow improvement, as a potential barrier to improvements in ED flow and efficiency?

6.8

7.4

6.5

6.9