Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada.
Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, K1N 6N5, Canada.
BMC Health Serv Res. 2020 Jan 17;20(1):47. doi: 10.1186/s12913-020-4897-0.
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.
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.
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.
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.
准备是成功变革的关键前提；它表示参与变革的人员是否有动力和能力参与变革。关于准备情况的研究往往侧重于一线提供者或非管理职位的个人，而对期望在变革实施中领导一线提供者的中层管理人员关注有限。然而，中层管理人员也是由更高职位的人员计划和颁布的变革的接受者。本研究试图在基层医疗项目整合的背景下，考察一线提供者和中层经理的变革准备情况。
我们采用定性案例研究方法，考察了一线提供者和中层经理在六个准备因素方面的经验：差距、适当性、价值、功效、公平和对管理层的信任。数据通过与参与变革的一线提供者和中层管理人员的文件、会议观察和半结构化访谈收集。
研究结果突出了一线提供者和中层管理人员准备情况的相似点和不同点。在这两种类型的参与者中，我们发现价值观念应该扩大，以考虑个人对患者和卫生系统的利益的评估；功效适用于变革的内容和过程；公平和对管理层的信任的发现需要进一步探索，以确定其在变革准备模型中的适当性；管理层的信任（或缺乏信任）对组织各级具有级联影响。
我们的研究通过细微差别和扩展个人准备因素的概念化，以及强调中层经理变革准备的核心作用，做出了贡献。研究的影响包括在实施变革之前考虑准备因素的必要性，以及在整个组织各级培养准备的重要性。
