Organizational Readiness for Evidence-Based Practice in Nursing

Introduction

We are living in a century that demands an accelerated rate of progress in healthcare. Advancements in healthcare organizations are not constant, and it is therefore critical to an organization's success that it maintains the ability to change its usual ways of practice. Change manifests across different dimensions — political, social, and financial — and an organization's tendency to adapt to change is a key indicator of its success (Diab, Safan & Bakeer, 2017). When an organization moves from its current state to a more desirable future state, this is referred to as organizational change. Organizational change management involves the preparation and application of both positive and negative changes within the organization, carried out in a way that reduces employee resistance and organizational cost while strengthening tolerance for change efforts. It is therefore advisable for people to prepare for change in order to reduce resistance to it (Vakola, Oreg & Armenakis, 2013).

Change is more likely to take place when those who embrace it outnumber those who oppose it. This is reflected in the model for individual and organizational change. The willingness of an individual to pursue therapeutic change originally informed the transtheoretical model in psychotherapy. In an effort to prepare stakeholders for change, the transtheoretical model emphasizes the need to remove obstacles to the change initiative and to cultivate the desire for change by introducing motivators — which may be either psychological or structural (Howley, 2012).

The following guidelines can help identify the best approach to change by breaking the process down from the status quo to the future state in five stages:

1. Craft the change
2. Plan the change
3. Put the change into effect
4. Manage the change
5. Sustain and maintain the change (Cavarec, 2014).

Failure by top management to support nursing staff at lower levels can be one of the primary barriers to change. Poor pay and lack of rewards, inadequate facilities and resources, insufficient information about the need for change, and the absence of staff training programs are all factors that impede change. Consequently, there is likely to be a lack of commitment, dissatisfaction, and reduced motivation among nursing staff to participate in change initiatives (El-Sayed, Seada & El-Guindy, 2017).

Managing change is clearly a complex process. It is also difficult to characterize and initiate in a rapidly changing world marked by diversity across cultures, ecologies, and organizational missions. Since leaders are obligated to make sound decisions and implement their conclusions, the guidance provided by theories of change is undoubtedly useful to them. Leaders can use models of change to prepare their organizations to adopt fresh methods of embracing change and achieving their objectives. Change management may be a more intricate skill than conventional science, as the ambiguity in current research on the topic underscores. Insights from practice are therefore invaluable to such leaders (Howley, 2012).

Literature Review

According to Jones et al. (2005), employees' perceptions of organizational culture are shaped by their fundamental human perspective. An organization with open relational values will be associated with higher levels of readiness for change, which in turn predicts the success of implementation. Analysis revealed that pre-implementation levels of readiness for change had a positive impact on employee satisfaction, given a system that is error-free and user-friendly. In a related study by Ingersoll et al. (2000), the relationships among organizational commitment, organizational culture, and organizational preparedness were examined in a group of employees participating in a hospital-wide redesign process. Results showed that when change is received positively, employees tend to invest greater effort and commitment in their institution's work. According to Treuer et al. (2018), an organization's overall readiness for change depends significantly on modifications to its organizational climate and leadership style.

Problem Statement and Methodology

This research was conducted to address the following problem statement: "What is the level of readiness of my organization's staff for evidence-based practice?" To determine how ready the organization was to incorporate evidence into practice, this study sought the opinions of nurse managers and staff nurses regarding the implementation of evidence-based practice (EBP) changes. It also examined the barriers that hinder the incorporation of practice changes.

Change readiness assessment seeks to evaluate readiness across three main dimensions: the circumstances, the individual approach, and the available resources in a system — assessed at all levels (Diab et al., 2017). The Prevention Program Assessment (PPA) tool will be used to evaluate how ready healthcare employees are to implement evidence-based practice. The tool was originally developed to assess organizational preparedness for evidence-based interventions in programs related to the prevention of chronic diseases, including asthma, obesity, and diabetes, among others. It can be particularly useful for public health practitioners who want to gauge their organization's readiness to launch evidence-based programs.

The tool comprises 23 questions across four categories: awareness, adoption, implementation, and maintenance. These are designed to guide users in evaluating a given organization's preparedness to apply evidence-based practice in both private and public health settings. The Prevention Program Assessment tool employs four basic stages for readiness assessment (Stamatakis et al., 2012):

1. Awareness: Assessing community and organizational awareness, and recognizing the availability and need for sources of evidence-based interventions (EBIs).
2. Adoption: Analyzing the extent to which evidence is used in decision-making.
3. Implementation: Implementing and adapting the intervention to fulfill community needs.
4. Maintenance: Ensuring the availability of resources and activities for the ongoing support of the innovation.

These four stages make the Prevention Program Assessment Tool a worthwhile instrument. It caters to both senior and junior staff, making it appropriate for this project. It should be used both at the beginning of training (pre-intervention) and after training (post-intervention). The training will cover, among other things, division of labor, discipline, decision-making, fair leadership, sustainable employment, comprehensive instruction, remuneration, and performance appraisal. The four stages span a period of six months, after which preparedness for change is re-evaluated using the tool (Cavarec, 2014).

The tool has been tested through interviews with samples representing study areas in chronic disease prevention. The degree of readiness was measured using confirmatory factor analysis (CFA). CFA was first applied to an initial four-factor model of organizational preparedness and was subsequently adapted using several model-fit indices, including the comparative fit index, chi-square/degrees of freedom, a 90% confidence interval, and root mean square error of approximation. CFA proved most appropriate for the 5-point scales of adoption and implementation and considerably improved the awareness and maintenance scales. The maintenance scale was further divided into four- and five-item scales: the four-point scale represents evaluation maintenance, while the five-point scale represents resource maintenance. The final scales demonstrated good fit, with factor loadings between 0.40 and 0.60. The readiness scale was also found to be sound, with ranges from 0.47 to 0.71 (Stamatakis et al., 2012).

This study will be conducted in healthcare centers and hospitals. Potential participants include hospital managers and registered nurses (RNs). Convenience sampling will be used for participant selection. All participants will be required to sign a consent form before taking part in data collection.

A non-randomized sample of registered staff nurses and nurse managers from acute and critical care units will be included. The objectives of the study will be explained to managers, who will then be asked to provide consent for the research to proceed. A cover letter will accompany the survey to provide additional information to staff. Approval will be sought from the hospital's Human Subjects Research Committee, and the researcher will ensure informed consent is obtained. Participant confidentiality will be maintained throughout. The PPA tool will be administered before the commencement of training; after the six-month training period concludes, it will be administered again to the same subjects. The difference in responses between the two time points will provide information about readiness for change.

Conclusion and Limitations

The healthcare sector requires a continuous focus on leadership traits even as leaders endeavor to implement other priorities such as climate change concerns. For instance, leadership training could be implemented alongside climate policies, enabling leaders to uphold evidence-based leadership behaviors while applying their implementation capabilities, thereby creating strategic climates conducive to change.

As this research has not covered all aspects of evidence-based practice, future researchers should examine the degree to which reduced formalization of Leadership and Organizational Change for Implementation (LOCI) frameworks would improve leadership standards. Past research has demonstrated how organizational development interventions can improve the workplace and enhance the overall patient experience. Future researchers may also explore how strategic climates can be tailored to sustain EBP implementation (Aarons et al., 2015).

References

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Bosch, M., Tavender, E. J., Brennan, S., Knott, J., Russell, L., & Green, S. (2016). The many organizational factors relevant to planning change in emergency care departments: a qualitative study to inform a cluster randomized controlled trial aiming to improve the management of patients with mild traumatic brain injuries. PLoS ONE, 11(2). doi:10.1371/journal.pone.0148091

Brown, C. G. (2014). The Iowa model of evidence-based practice to promote quality care: An illustrated example in oncology nursing. Clin J Oncol Nurs, 18, 167–169.

Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014, North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.

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Diab, G. M., Safan, S. M., & Bakeer, H. M. (2018). Organizational change readiness and managers' behavior in managing change. Journal of Nursing Education and Practice, 8(7). doi: 10.5430/jnep.v8n7p68

El-Sayed, F., Seada, A., & El-Guindy, H. (2017). Factors associated with nurses' readiness for organizational change at BeniSueif University Hospital. Egyptian Nursing Journal, 14(2), 141–151.

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Howley, C. (2016). Readiness for change. ICF International. Retrieved from https://files.eric.ed.gov/fulltext/ED535400.pdf

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Appendix A: The Prevention Program Assessment Survey

Instructions: By answering the following questions, you will help us understand how well you are versed in evidence-based practice. A scale of 1 to 7 is provided for each question. Choosing 1 means you fully disagree with the statement; choosing 7 means you fully agree.

The community upholds involvement as a way to address problems.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The community recognizes medical issues as a problem.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The leaders of the organization know where EBIs originate from.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The staff in the organization know where EBIs originate from.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The leaders in the organization promote the use of EBIs.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

EBIs are easily accepted into the organization.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

Managers rely on findings from research studies.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization currently uses findings from research studies.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

There is full access to assistance in applying research evidence.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization has the means to implement EBIs.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

EBIs are supported by the leaders of the organization.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization employs EBIs to satisfy the needs of those it serves.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

Community leaders support EBIs.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The persons authorized to implement EBIs are skilled in doing so.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization aims to retain the EBI implementation team.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization collaborates with other agencies and shares resources with them.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization obtains its finances from a number of sources.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization has well-developed fiscal policies.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

During financial constraints, EBIs will still be practiced.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization continuously assesses the progress of EBIs.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization had previously considered evaluating EBIs.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization shares its findings with the community.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

The organization conducts community needs assessments.
1 — 2 — 3 — 4 — 5 — 6 — 7 (Fully disagree → Fully agree)

Appendix C: Consent Form

I, the undersigned, agree to the request of the researcher to evaluate the status of EBIs in our organization. I have carefully read the requirements of the research and am fully in agreement. The researcher has also assured me in writing that they will uphold the code of ethics required for studies of this nature. In acknowledging this, I confirm that:

1. The researcher has briefed me on the objective of the research and made it clear that all data collected from me will be used exclusively for the study.
2. I have authorized the researcher to inquire about my participation in the study.
3. This is a voluntary engagement, from which I am free to withdraw at any time.
4. No participant in the study will have their identity disclosed, and all data obtained will be used solely for study purposes.

Appendix D: Timeline and Budget

December 2018 — Complete coursework and sit for end-of-term exams.
February 2019 — Mobilize the committee and register for thesis.
Spring 2019 — Defend thesis.
Summer 2019 — Seek approval of research plan from the Institutional Review Board.