Organizational readiness in specialty mental health care.
BACKGROUND
Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia.


OBJECTIVE
To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies.


METHODS
EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline.


METHODS
At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed.


RESULTS
The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters.


CONCLUSIONS
Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.
Hamilton
Alison B
AB
VA Desert Pacific Mental Illness Research, Education and Clinical Center, and UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, USA. alisonh@ucla.edu
Cohen
Amy N
AN
Young
Alexander S
AS
D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008603:Mental Health; D009042:Motivation; D009936:Organizational Innovation; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000639:trends