An analysis of features of respiratory therapy departments that are avid for change.
BACKGROUND
Models of organizational change-readiness have been developed, but little attention has been given to features of change-avid health-care institutions, and, to our knowledge, no attention has been given to features of change-avid respiratory therapy (RT) departments.


METHODS
We conducted an exploratory study to compare RT departments we deemed change-avid or non-change-avid, to identify differentiating characteristics. Our assessments regarding change-readiness and avidity were based on structured, in-person interviews of the technical directors and/or medical directors of 8 RT departments. Based on a priori criteria, 4 of the 8 RT departments were deemed change-avid, based on the presence of > or = 2 of the following 3 criteria: (1) uses a management information system, (2) uses a comprehensive RT protocol program, (3) uses noninvasive ventilation in > 20% of patients with exacerbation of chronic obstructive pulmonary disease. Our ratings of the departments were based on 2 scales: one from Integrated Organizational Development Inc, and the 8-stage change model of Kotter.


RESULTS
The ratings of the 4 change-avid departments differed significantly from those of the 4 non-change-avid departments, on both the Integrated Organizational Development Inc scale and the Kotter scale. We identified 11 highly desired features of a change-avid RT department: a close working relationship between the medical director and the RT staff; a strong and supportive hospital "champion" for change; using data to define problems and measure the effectiveness of solutions; using redundant types of communication; recognizing resistance and minimizing obstacles to change; being willing to tackle tough issues; maintaining a culture of ongoing education; consistently rewarding change-avid behavior; fostering ownership for change and involving stakeholders; attending to RT leadership succession planning; and having and communicating a vision for the department.


CONCLUSIONS
In this first exploratory study we found that change-avid RT departments can be differentiated from non-change-avid RT departments with available assessment tools. Highly desired features of a change-avid RT department were identified but require further study, as does the relationship between change-avidity and clinical outcomes.
Stoller
James K
JK
Section of Respiratory Therapy, the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA. stollej@ccf.org
Kester
Lucy
L
Roberts
Vincent T
VT
Orens
Douglas K
DK
Babic
Mark D
MD
Lemin
Martha E
ME
Hoisington
Edward R
ER
Dolgan
Colleen M
CM
Cohen
Harlow B
HB
Chatburn
Robert L
RL
D019033:Delivery of Health Care, Integrated / Q000639:trends*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012124:Respiratory Care Units / Q000458:organization & administration*; D012138:Respiratory Therapy / Q000639:trends*; D014481:United States