Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1032 — Readiness in Context: A Literature Synthesis of Organizational Readiness Measures Mapped to an Implementation Framework

Lead/Presenter: Isomi Miake-Lye
All Authors: Miake-Lye I (Care Coordination QUERI, VA Greater Los Angeles Healthcare System; UCLA School of Public Health) Ganz DA (Care Coordination QUERI, VA Greater Los Angeles Healthcare System; UCLA School of Medicine) Mittman BS (Care Coordination QUERI, VA Greater Los Angeles Healthcare System; Kaiser Permanente Southern California) Delevan DM (Care Coordination QUERI, VA Greater Los Angeles Healthcare System) Finley EP (Care Coordination QUERI, VA South Texas Healthcare System; The University of Texas Health Science Center at San Antonio)

Objectives:
While there is a long history of developing and validating organizational readiness assessments as important tools for successful implementation, readiness is conceptualized in diverse ways across the research literature, and it remains unclear how best to operationalize readiness across varied implementation projects or settings. We conducted an inductive synthesis of published readiness instruments to identify core components of readiness using content analysis and conceptual mapping.

Methods:
We identified readiness instruments using a systematic review (Gagnon 2014). Individual items were mapped to the Consolidated Framework for Implementation Research (CFIR) -- which identifies five core implementation domains (e.g., inner setting) and multiple constructs within each domain (e.g., learning climate, culture) -- using a team-based coding process.

Results:
Of 26 instruments identified, 15 were available. Of 707 total survey items, 410 (58%) mapped to inner setting, most commonly related to constructs of learning climate (e.g., feeling safe to propose change, n = 88); culture (e.g., supportive peers, n = 73); structural characteristics (e.g., organization size, n = 56); and tension for change (e.g., perception that change is needed, n = 54). One hundred forty five items (21%) mapped to characteristics of individuals (mainly personal traits [n = 70]); 42 (6%) mapped to outer setting; 41 (6%) mapped to implementation process; 25 (3%) mapped to intervention characteristics; and 44 (6%) did not map to CFIR constructs. Instruments were typically tailored to specific interventions.

Implications:
Available readiness instruments predominantly focus on inner setting contextual factors, especially learning climate, culture, structural characteristics, and tension for change. These findings suggest that instrument developers consistently value these as core components of readiness assessment, but also see the practical need to tailor assessments to meet the needs of individual projects or settings, which introduces variability in question phrasing and inclusion of other implementation domains.

Impacts:
We are currently developing a toolkit to support implementation readiness assessment. In the meantime, evaluators seeking a parsimonious approach to measuring readiness should consider prioritizing assessments that cover learning climate, culture, organizational structural characteristics, and tension for change. Other factors should be considered depending on their relevance to the particular implementation project being evaluated.