Table 2 Elements of receptivity

Change agenda and its locale

The element's focus is on the fit between the agenda and factors in the local, external environment that might influence internal change efforts.

Cooperative inter-organizational networks

Development and management of links with other agencies, e.g., through boundary spanners.

(Long term) Environmental pressure

The intensity and scale of pressures from influential agents external to the organization.

Key people leading change

• Defined by the team in terms of roles in which an individual influences others, more specifically, in terms of strategic versus operational influence, i.e., influencing others to behave in certain ways toward preconceived group goals (Schein) ___ in this case EBP in a department of nursing.

• Types of roles were defined as formal, or managerial and related to positions of authority at all levels; or informal. Informal leaders included both clinical support personnel, such as APNs (Advance Practice Nurses) and special types of staff or EBP roles, either formal or informal.

Quality and coherence of policy

• The meaning of policy is broad, e.g., in the form of a broad vision, and not specifically about local policies and procedures.

• More focused on strategic decisions relative to change, with quality referring to the related evidence base, related conceptual thinking about such decisions, and eventual buy-in

• Coherence reflects initial exploration of a vision's congruence among related 'goals'; attention to politics and needed negotiation with key stakeholders; feasibility; and skill in terms of how the targeted strategic change was managed. In this study such congruence was defined as not only including development/refinement of organizational components on paper but the actual operationalization of such infrastructures for EBP; i.e., organizational structures, systems, roles, processes, relations, alignments, and capabilities.

Managerial-clinical relations

The quality of the interface between staff and management.

Simplicity and clarity of goals

• The ability 'to narrow the change agenda down into a set of key priorities, and to insulate this core from the constantly shifting short-term pressures' [34].

• Demonstrates managerial '... persistence and patience in pursuit of objectives over a long period' [34].

Supportive organizational culture

Defined by the study team as the way things are done in an organization that is supported by its values, norms and expectations. Such forces in an organizational social system affect behavior of individuals.

   Culture can be characterized as strong or weak. In an organization with a strong culture there is high agreement among individuals regarding expectations and values, whereas the level of agreement regarding values and expectations is low or highly variable in a weak culture.

   Regarding EBP, values and expectations regarding use of evidence are direct aspects of a culture supporting evidence based practice. Related characteristics of a culture, such as values supporting collaboration and teamwork, are expected to support EBP.