Examining health care providers’ and middle-level managers’ readiness for change: a qualitative study

Abstract

Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals' evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.

Goal-Oriented Care: A Catalyst for Person-Centred System Integration

“…The CHC led a voluntarily formed Health Links network (of various health and social organizations in the region) that aimed to work together to better coordinate care for patients with complex health and social needs. Given the overlap in their activities and aims, Health Links and the seniors outreach program were later integrated to expand seniors’ access to care coordination [ 38 ].…”

The ELIAS framework: A prescription for innovation and change

“…These innovations then become incorporated into standard operational procedures and policies and procedures in the routinization phase (Figure 1). 15,17,31 –33 Although the ELIAS framework is represented as cyclical, moving from one stage to the next may not always be linear because evaluation may cause a shift to a previous stage due to unanticipated factors such as inadequate resources, changes in strategic direction, or poor performance of proposed solutions. 10…”

“…Unfortunately, sometimes the awareness of a performance discrepancy is not enough to cause the disconfirmation of current practices and a search to close the performance gap. 10,16,28,29,31 This is the reason emphasis was placed on input in measurement design from all stakeholders affected by the measures or who affect them. This way there is an improved chance of acceptance of the information provided by the measures.…”

“…In addition, the presence of a culture that embodies the precepts outlined in Table 1 is also important for the acceptance of the information provided by performance measurement. 3,9,31 –33…”

“…26,28,34 Solutions represent a congruence between the resources of the organization; the organization’s culture; its strategic direction, and the criteria for success set out by stakeholders involved in solution generation. 23,29,31,32,35 Solutions must also demonstrate practice-based evidence reflected by local pilot testing to assess their viability within the organizational context where it will be implemented. This makes it easier for previous practices to be discontinued (disconfirmation) and innovations to be implemented.…”