Change management experts have emphasized the importance of establishing organizational readiness for change and recommended various strategies for creating it. Although the advice seems reasonable, the scientific basis for it is limited. Unlike individual readiness for change, organizational readiness for change has not been subject to extensive theoretical development or empirical study. In this article, I conceptually define organizational readiness for change and develop a theory of its determinants and outcomes. I focus on the organizational level of analysis because many promising approaches to improving healthcare delivery entail collective behavior change in the form of systems redesign--that is, multiple, simultaneous changes in staffing, work flow, decision making, communication, and reward systems.
The theory described in this article treats organizational readiness as a shared psychological state in which organizational members feel committed to implementing an organizational change and confident in their collective abilities to do so. This way of thinking about organizational readiness is best suited for examining organizational changes where collective behavior change is necessary in order to effectively implement the change and, in some instances, for the change to produce anticipated benefits. Testing the theory would require further measurement development and careful sampling decisions. The theory offers a means of reconciling the structural and psychological views of organizational readiness found in the literature. Further, the theory suggests the possibility that the strategies that change management experts recommend are equifinal. That is, there is no 'one best way' to increase organizational readiness for change.
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What is the end result of all this change-related effort? Drawing on implementation theory, the most proximal outcome is likely to be effective implementation. Following Klein and Sorra [55], implementation effectiveness refers to the consistency and quality of organizational members' initial or early use of a new idea, program, process, practice, or technology. To illustrate, when organizational readiness for change is high, community health centers providers and staff will more skillfully and persistently take action to put a diabetes registry in practice and demonstrate more consistent, high-quality use of the registry. By contrast, when organizational readiness for change is low or nonexistent, community health center providers and staff will resist initiating change, put less effort into implementation, persevere less in the face of implementation challenges, and exhibit compliant registry use, at best. In the absence of further intervention, registry use is likely to be intermittent, scattered, and uneven.
Because this theory of organizational readiness for change is pitched at the organizational level of analysis, a test of the theory's predictions would require a multi-organization research design in which a set of organizations implements a common, or at least comparable, complex organizational change. A large healthcare system implementing Six Sigma or lean manufacturing on a system-wide basis would provide a useful opportunity to test the theory. So too would an association of community health centers agreeing to implement a common multi-component diabetes management program, or a group of affiliated specialty practices deciding to implement a common electronic medical record.
In this article, I sought to conceptually define organizational readiness for change and develop a theory of its determinants and outcomes. In contrast to much of the literature on the topic, the conceptual definition offered here treats organizational readiness as a shared team property--that is, a shared psychological state in which organizational members feel committed to implementing an organizational change and confident in their collective abilities to do so. This way of thinking about organizational readiness is best suited for organizational changes where collective, coordinated behavior change is necessary in order to effectively implement the change and, in some instances, for the change to produce anticipated benefits. Some of the most promising organizational changes in healthcare delivery require collective, coordinated behavior change by many organizational members. Electronic health records, chronic care models, open access scheduling, quality improvement programs, and patient safety systems are but a few examples. There are, however, many evidence-based practices that providers could adopt, implement, and use on their own with relatively modest training or support (e.g., smoking cessation counseling, foot exams for diabetic patients). Often such practices can generate benefits for individual providers, or their patients, regardless of whether other providers also adopt, implement, or use them. Individual-level theories of behavior change--such as the theory of planned behavior or the trans-theoretical model of change--apply more readily to such cases than organization-level theories do because the adoption, implementation, use, and outcomes of such evidence-based practices do not depend on collective, coordinated behavior change. The greater the degree of interdependence in change processes and outcomes, the greater the utility of supra-individual theories of readiness, such as the one presented here.
Second, the article's discussion of determinants illuminates the theoretical basis for the various strategies that change management experts recommend for creating organizational readiness. For practitioners, it might not seem necessary to explain in theoretical terms how or why a strategy works. For researchers, however, theoretical explication of the pathways through which these strategies affect readiness is important for advancing scientific knowledge. The theory that I propose suggests that strategies such as highlighting the discrepancy between current and desired performance levels, fomenting dissatisfaction with the status quo, creating an appealing vision of a future state of affairs increase organizational readiness for change by increasing change valence--that is, by increasing the degree to which organizational members perceive the change as needed, important, or worthwhile. In addition to advancing scientific knowledge, identifying and testing the pathways through which actions (strategies) have effects can have practical implications as well. Such efforts can prompt the discovery of new strategies or alternative pathways, or they can show the equifinality of already known strategies. For example, in the theory that I describe, the keys to increasing readiness are raising change valence and promoting a positive assessment of task demands, resource availability, and situational factors. It seems unlikely that there is one best way to achieve these goals; at the same time, it seems unlikely that all ways are always equally effective. Creating a sense of urgency might be useful for increasing change valence in some situations (i.e., when complacency is high), but not others (i.e., when uncertainty is high). Likewise, end-user involvement in change design and implementation planning can be a powerful way for not only increasing change valence (e.g., helping people to see why this change is needed, important, and worthwhile), but also for helping organizational members realistically appraise the match of task demands, available resources, and situational factors. When, for whatever reason, end-user involvement is not an appropriate or feasible strategy, vicarious learning strategies (e.g., site visits) could be useful for supplying organizational members with accurate information about task demands, resource requirements, and situational factors affecting implementation. If readiness-enhancing strategies are indeed equifinal--and this is an empirical question--then organizational leaders, innovation champions, and other change agents could take with a grain of salt the 'one best way' advice so often found in prescriptive change management writing, and focus instead of developing and using strategies that are tailored to local needs, opportunities, and constraints.
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