Table 1 Pre-implementation themes by the theory of organizational readiness for change
Organizational situation | |||
Organizational readiness to change | |||
Degree to which organization members perceive that the organization, as opposed to the individual, is prepared to implement a specific intervention. | |||
Positive factors | Â | Negative factors | |
+ | Buy-in from administration | - | Nurse commitment hard to gauge |
+ | Buy-in from providers | - | Nurses may be reluctant because of other job tasks |
+ | Clinic accustomed to innovation | - | Clinic leaders don’t know what to expect |
+ | Dovetails with priorities | - | Implementation has taken a back seat |
+ | Clinic is committed b/c benefits are understood in terms of research, medical understanding and telehealth | Â | Â |
+ | Core team is committed and communicating that, and wouldn't do if it wasn’t important |  |  |
Change valence | |||
Value that organizational members attribute to a proposed change. | |||
Positive factors | |||
+ | Research is part of culture | ||
+ | Self-management behavioral interventions viewed positively | ||
+ | Increased access to care | ||
+ | Clinicians view program will be beneficial for patients | ||
+ | Extremely important to control BP | ||
RN scope of practice | |||
+ | Better job satisfaction | ||
+ | Active in patient panel | ||
+ | Active in population management | ||
+ | Using more skills as nurses | ||
+ | Better job satisfaction | ||
Change valence is temporary (these are both positive & negative factors) | |||
+/− | Buy-in from patients needed | ||
+/− | Patient perspective is needed in implementation and evaluation | ||
+/− | Belief in program will depend on seeing evidence; thinks maybe the key is in not letting patients fall through the cracks | ||
+/− | Feedback from patients on satisfaction with program is important | ||
+/− | Interested to see if Motivational Interviewing affects HTN patient self-management | ||
+/− | Success depends on seeing patient data measurements (BP control; smoking; weight) | ||
+/− | Wait and see attitude | ||
+/− | Qualitative and quantitative evidence is important for continued success | ||
Situational factors | |||
Organizational contextual situations that affect the confidence and commitment of organizational members to implement the intervention | |||
Positive factors | Negative factors | ||
| Â | Â | Timing of change effort | Â |
+ | Aligns with clinic workflow and External Peer Review Program (EPRP) | - | Length of time to implementation is a barrier |
+ | Aligns with values of PACT (patient-centered care & care teams) | - | Can’t remember what HTN Improve is |
+ | Other programs will support HTNI (e.g., telehealth, MOVE, Pact, HTN clinic) | - | Don’t know what happened to HTN Improve |
+ | Will be better or add to current programs/patient contact frequency | - | Eager to start |
Technology | Â | - | Long time ago |
+ | Will be added to existing technology infrastructure | - | Many existing BP interventions |
| Â | - | Need to make PCP aware of program | |
Time available | Â | ||
- | Clinic visit time is limited to introduce patients to the intervention | ||
- | Nurses are concerned about time available | ||
Technology | Â | ||
- | Security challenges with access to software | ||
- | Interoperability issues | ||
Task demands | |||
Knowledge about the tasks that need to be performed, resources that are needed, and the time and effort that are needed to implement the intervention | |||
Positive factors | Negative factors | ||
+ | Behavioral self-management intervention | - | Coordinating outreach to patient could be a burden |
+ | RN delivered calls | - | Implementation will be seen as adding one more thing to a nurse’s full plate |
| Â | Â | - | Another clinical reminder |
| Â | Â | - | Contacting patients is challenging |
| Â | Â | - | Integration into existing workflow with minimal steps is needed |
Resource perceptions | |||
Access to financial, material, or human assets to support implementation and ongoing use of the intervention | |||
+ | Have office space | - | Need a dedicated research staff |
+ | Have staffing for HTNI | - | Staffing is an issue |
+ | Use existing equipment | Â | Â |
+ | Have IT support | Â | Â |
+ | Fairly knowledgeable about intervention | Â | Â |
Contextual factors | |||
Broader contextual conditions that affect organizational readiness for change | |||
+ | Clinic accustomed to innovation | - | No dedicated research staff |
+ | Research is part of the culture | - | IT is undergoing infrastructure change |
+ | Past experience with implementing research | Â | Â |
+ | Other programs will support HTNI (e.g., telehealth, MOVE, Pact, HTN clinic) | Â | Â |
+ | Telemedicine is part of the VA culture and delivered by RNs | Â | Â |