Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
BMC Health Serv Res. 2019 Jul 24;19(1):517. doi: 10.1186/s12913-019-4319-3.
As health care strives towards the Triple Aim of improved population health, patient experience, and reduced costs, an organization's readiness for change may be a key factor. The concept refers to the collective commitment of organizational members to a change and belief in their shared ability to make that change happen (efficacy). This study aims to assess the organizational readiness for implementing large-scale change at a clinical department in pursuit of the Triple Aim and to determine key associated factors.
A cross-sectional study at a Danish Obstetrics and Gynecology department faced with external pressure to become more efficient without compromising patient outcomes and experience. The Organisational Readiness for Implementing Change (ORIC) questionnaire was distributed to all employees (n = 403). Descriptive statistics was used to assess overall organizational readiness and single items. The between-group differences in subject characteristics were assessed with independent t-test and non-parametric test. Multiple linear regression was employed to control for potential confounders.
Response rate was 72%. The level of agreement with the commitment statements was high, and low with the efficacy statements. We did not observe statistically significant differences in the overall score between organizational sections or in relation to gender, age, or profession. Managerial status (B = 3.2, 95% CI = .52, 5.9, P = .02) or interim employment(B = 2.7, 95% CI = .47, 4.9, P = .02) were significant predictors of a high change efficacy score after controlling for potential confounders.
Changes related to pursuit of the Triple Aim were seen as something that "has to" be done, but left managers, and even more so staff, wondering what "to do" and "how to" do it. Change strategies should therefore address these uncertainties by translating political "have to's" proposals that resonate with staff, spark engagement, and clarify "how to" deal with the complexity of large-scale change.
随着医疗保健努力实现改善人口健康、患者体验和降低成本的三重目标，组织对变革的准备可能是一个关键因素。这个概念是指组织成员对变革的集体承诺和对实现变革的共同能力的信念（效力）。本研究旨在评估丹麦妇产科临床科室实施大规模变革以追求三重目标的组织准备情况，并确定关键相关因素。
在丹麦妇产科面临提高效率而不影响患者结果和体验的外部压力下，进行了一项横断面研究。向所有员工（n=403）发放了组织变革实施准备情况（ORIC）问卷。采用描述性统计方法评估整体组织准备情况和单项指标。采用独立 t 检验和非参数检验评估组间特征差异。采用多元线性回归控制潜在混杂因素。
应答率为 72%。对承诺陈述的一致性程度较高，对效力陈述的一致性程度较低。我们没有观察到组织结构部分之间的整体得分存在统计学差异，也没有观察到性别、年龄或职业的差异。管理地位（B=3.2，95%CI=0.52,5.9，P=0.02）或临时就业（B=2.7，95%CI=0.47,4.9，P=0.02）是控制潜在混杂因素后高变革效力得分的显著预测因素。
追求三重目标的变革被视为“必须”要做的事情，但让管理者，甚至更多的员工，不知道要做什么和怎么做。因此，变革策略应该通过将政治上的“必须”提案转化为与员工产生共鸣、激发员工积极性并阐明如何应对大规模变革的复杂性，来解决这些不确定性。
