Adelson Pamela, Yates Rachael, Fleet Julie-Anne, McKellar Lois
Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, City East Campus, Playford Building P4-27, North Terrace, Adelaide, SA, 5000, Australia.
Rural Support Service, South Australia Health, Government of South Australia, Mount Gambier Health Service, Mount Gambier, SA, 5290, Australia.
BMC Health Serv Res. 2021 Apr 20;21(1):368. doi: 10.1186/s12913-021-06373-9.
The sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.
A descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant's commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.
Overall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12-60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, "People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements "People who work here are determined to implement this change", "People who work here want to implement this change", and "People who work here are committed to implementing this change.
Results of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.
由于当前劳动力短缺，澳大利亚农村地区的孕产妇服务可持续性受到威胁。2019年7月，南澳大利亚农村地区实施了一种新的助产士个案管理护理模式，以提供助产士连续性护理，并促进该地区劳动力的可持续性。该模式独特之处在于它将五个分娩地点整合在一起，连接了助产士、医生、护士和社区团队。成功实施的一个关键前提是要求参与该模式的人员准备好接受变革。我们对五个地点转向新护理模式的临床医生进行了调查，以评估他们对实施变革的组织准备情况。
一项评估变革准备情况的描述性研究使用了实施变革的组织准备量表（ORIC）进行测量。这个12项的李克特量表衡量参与者对变革的承诺和变革效能。所有在护理模式内工作的临床医生（助产士、护士和医生）都被邀请完成一项电子调查。
总体而言，参与该模式的临床医生中有55%（56/102）做出了回应。ORIC平均得分是41.5（范围为12 - 60），这表明总体而言，助产士、护士和医生开始新护理模式时具有变革准备意识。参与者最有可能认同变革效能陈述，即“在这里工作的人相信组织能够让人们投入到实施这一变革中”，以及变革承诺陈述，即“在这里工作的人决心实施这一变革”、“在这里工作的人想要实施这一变革”和“在这里工作的人致力于实施这一变革”。
ORIC调查结果表明，转向新护理模式的临床医生愿意接受变革并致力于新模式。医疗保健环境中的组织变革过程具有挑战性且是一个持续的过程。如果变革准备程度高，组织成员会在变革努力中投入更多，并表现出更大的毅力来克服障碍和挫折。这是该工具在澳大利亚助产士和护士中首次被报道使用，应考虑在其他国内和国际临床实施研究中使用。
