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Table 1 Pre-implementation themes by the theory of organizational readiness for change

From: Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

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   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   
+ 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
   Timing of change effort  
+ 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   - Long time ago
+ Will be added to existing technology infrastructure - Many existing BP interventions
  - Need to make PCP aware of program
Time available  
- Clinic visit time is limited to introduce patients to the intervention
- Nurses are concerned about time available
Technology  
- 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
   - Another clinical reminder
   - Contacting patients is challenging
   - 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   
+ Have IT support   
+ Fairly knowledgeable about intervention   
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   
+ Other programs will support HTNI (e.g., telehealth, MOVE, Pact, HTN clinic)   
+ Telemedicine is part of the VA culture and delivered by RNs