By Lori Moore, MPH, MSCE, BSN, RN
Change is a constant in healthcare, and over the past few years, the pace has quickened. And the fact that there has been little time to prepare has made implementing change even more difficult. Healthcare organizations have had to move from an initial idea to full-scale implementation with little to no time for people to adjust to the concept of the change. Today, as we seem to be in the midst of a new post pandemic phase, a calmer period comparatively speaking, this might be a good time to rethink how we prepare our people for change.
At its very core, change is about doing away with the old ways and adopting new ways of doing things. This requires uprooting longstanding habits and building new habits and practices and ways of working. But the reality is, the “old ways” are familiar. They feel good and safe. They bring a certain level of comfort. And people are not likely to be successful at adopting new ways of working without some psychological and behavioral preparation.1-2 Therefore, the primary focus of any change effort should be on its people. Do they understand the why behind the change? Have they acknowledged the problem that led to the need for change? Do they feel that they have the resources to successfully implement the change? For the majority of leaders, the answers to these questions may be an unknown.
Experts in organizational change assert that readying individuals for change is an essential yet often overlooked precursor to the adoption of new practices.2-3 Readiness is defined as the degree to which change recipients are individually and collectively prepared, motivated, and technically capable and willing to carry out the change.4 When readiness is low, people are more likely to view the change as undesirable and sidestep or even resist participating in the change process.1
Leaders can plant seeds for successful change in the early stages of the planning process by building readiness for the change. There are five key elements to help guide the readiness strategy.2,5-7
- Discrepancy: This is about sharing with people that there is a gap between the current performance and the desired end state to help create motivation. The need for change needs to make sense to those who are being called to change their behaviors. And ideally the messaging should include some type of contextual factors such as data that you can share, new regulations or guidelines or well-acknowledged deficits in safety or quality of care.
- Appropriateness: People cannot accept that a given change is the best response without first recognizing that there is a discrepancy between the current and desired state. To be motivated to change, people need to understand that there is a problem, and they must believe, at least to some extent, that the solution that is chosen makes sense for that particular problem.
- Efficacy: Change efficacy reflects the confidence people have in their ability to successfully implement the change. Do people understand what is expected of them? Do they think that the ask is attainable? Do they have the skill set, the resources? Can the system within which the change is being implemented support the change? People will push back on changes that they perceive to be outside their capabilities.
- Principal support: Change requires resources and commitment. Many change efforts have stalled due to lack of support. People will be looking to see if leaders are walking the talk and providing necessary resources. The change will be successful only to the extent that leaders are willing to provide support.
- Valence: People will evaluate the value of the change for their job or role. Is it needed, important, beneficial, worthwhile? The greater an individual’s perception of the benefit or value of the change, the more likely they are to want to participate in the change.
Implementing change is a challenge for healthcare organizations. And often times it isn’t the change itself that is the fulcrum between success and failure, but how the change is brought about that determines success. Changing long-standing habits and practices and building new ways of working is dependent on whether the people who are on the receiving end of the change have been prepared and are motivated and feel empowered to incorporate the change into their work world.
By understanding readiness, leaders can improve the adoption and institutionalization of new evidence-based practices.
Lori Moore, MPH, MSCE, BSN, RN
GOJO Clinical Educator.
Lori provides clinical support and education to healthcare professionals to improve hand hygiene compliance.
- Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implement Sci. 2014;9:7.
- Weiner BJ. A theory of organizational readiness for change. Implement Sci. 2009;4:67.
- Armenakis AA, Harris SG, Mossholder KW. Creating readiness for organizational change. Human Relations. 1993;4;681-703.
- Scaccia JP, Cook BS, Lamont A, et al. A practical implementation science heuristic for organizational readiness: R = MC2. J Community Psychol. 2015;43(4):484-501.
- Armenakis AA, Harris SG. Crafting a change message to create transformational readiness. J Organ Change Manag. 2001;15:169-183.
- Austin T, Chreim S, Grudniewicz A. Examining health care providers’ and middle-level
managers’ readiness for change: a qualitative study. BMC Health Serv Res. 2020;20(1):47.
- Rafferty AE, Jimmieson NL, Armenakis AA. Change readiness: a multilevel review. J Manag. 2013;39:110-135.