Randall C L, Hort K, Huebner C E, Mallott E, Mancl L, Milgrom P, Nelson L, Senturia K, Weiner B J, Cunha-Cruz J
Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.
Southeast Alaska Regional Health Consortium, Juneau, AK, USA.
JDR Clin Trans Res. 2020 Apr;5(2):156-165. doi: 10.1177/2380084419871904. Epub 2019 Sep 9.
Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure.
The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness.
A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics.
Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for.
Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities.
The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.
部落医疗保健系统正在努力进行内部变革，以改善美国印第安人和阿拉斯加原住民儿童获得牙科护理的机会和服务，并减少健康不平等现象。在类似的系统中，实施变革的组织准备情况与系统层面变革的采用情况相关，并受到包括文化、资源和结构在内的组织因素的影响。
本研究的目的是评估一个部落医疗保健组织实施与提供循证牙科护理相关变革的组织准备情况，并确定与准备情况相关的劳动力和感知工作环境因素。
78名员工（包括牙科提供者、牙科助理和支持人员）在线完成了一份92项的问卷（回复率为88%）。该问卷询问了实施准备情况（实施变革的组织准备情况）、组织背景和资源、劳动力问题、组织功能和人口统计学信息。
变革承诺和变革效能领域（实施准备情况）的平均得分分别为3.93（标准差 = 0.75）和3.85（标准差 = 0.80），最高得分为5分。当考虑所有其他变量时，组织功能的一个方面——感知管理质量，是实施变革准备情况的唯一显著预测因素（B = 0.727，标准误 = 0.181，P < 0.0002）。
结果表明，当部落医疗保健组织的工作人员（包括牙医、牙科治疗师、口腔卫生员、助理和支持人员）认为管理质量高时，他们更支持促进循证实践的组织变革。变革准备得分表明一个组织有能力在机构层面采用新政策和程序。在这种情况下，使用更有效的管理策略可能是增强机构行为以改善人群健康和减少健康不平等现象的最关键变革之一。
本研究结果可供在牙科护理组织内实施变革的临床医生和其他领导者使用。为了促进组织对变革的准备，并最终使利益相关者更迅速、高效地采用系统层面的变革，应总体考虑组织功能，尤其要考虑管理实践的质量。
