title: 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.
abstract: BACKGROUND
  Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success.
  
  
  OBJECTIVE
  Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change?
  
  
  METHODS
  Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation.
  
  
  RESULTS
  Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses.
  
  
  CONCLUSIONS
  The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 411 West Chapel Street, suite 600, Durham, NC, USA. Ryan.shaw@duke.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Kaufman
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Shoou-Yih Daniel
authors.initials: SY
authors.lastname: Lee
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kravetz
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rakley
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowen
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Del Monte
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
mesh_terms: D001794:Blood Pressure; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000451:nursing; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D017216:Telemedicine; D014481:United States