If an organization is all set for change, it is more likely to be able to implement new programs, and so assessing – and attending to – the readiness of the one is likely to improve the prospects of the other.

That’s the theory. But does it work in practice? Two studies presented at this week’s National Institutes of Health conference in Bethesda, Maryland, shed some light.
 
Amy Cohen and colleagues from the University of California, Los Angeles, have been studying organizational assessment in the context of efforts to improve care for individuals with schizophrenia.
 
In a three-year trial involving eight medical centers, four intervention sites were encouraged to use evidence-based interventions, such as support with return to employment and participation in "wellness" (weight loss) programs.
 
In all sites, and prior to implementation, clinicians and administrators completed the organizational readiness for change (ORC) measure and key stakeholders at the four intervention sites also completed a qualitative interview.

The ORC covers areas such as motivation to change, staff perceptions and beliefs and organizational climate. Scores on each scale range from 10-50; 30 or over is taken to indicate a state of adequate readiness.
 
In two of the sites, scores were moderate, consistent across scales – and satisfactory. In another, there was a very varied response to a key motivational question about whether the clinic needed more services to meet the needs of patients. The research team therefore tried to heighten awareness of gaps in care, for example by talking to opinion leaders and offering education by experts.
 
The fourth site exhibited a strong variation in terms of its openness to change, so the team tried to strengthen the sense of mission and cohesion.
 
The conclusion was that each intervention site had different strengths and weaknesses, a circumstance that would not have been revealed but for the combined use of the ORC and semi-structured interview data.
 
In the second study, Hildi Hagedorn and a team from the University of Minnesota School of Medicine arrived at similar conclusions using a different measure, the Organizational Readiness to Change Assessment (ORCA).

Their aim was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics. 

Staff in nine US clinics participated in a six-month training program. A representative from each team completed the ORCA Evidence and Context scales in advance to give an indication of the prevailing attitude to evidence, and the quality and nature of leadership and resources.
 
Clinic teams were categorized into high [n=4] and low [n=5] performers based on how many hepatitis prevention practices – universal screening, vaccines, education and so on – were integrated into their clinics after completing the training program.
 
The study team found a positive correlation, varying across sub-scales, between high and low implementation scores and the level of organizational readiness as measured at the outset using the ORCA.
 
The researchers acknowledge that studies using larger sample sizes will be necessary to support their preliminary findings, but they argue that the ORCA appears to be useful in predicting implementation success, and that it could help identify sites that need extra support, as well as enabling those who provide such support to tailor it.

This last simple insight may prove to be the most important. Assessments of organizational readiness can seem threatening to those on the end of them, and there is acknowledgment on the part of those undertaking them that no organization is ever truly “ready”.

More constructive, then, to see assessment as a tool to help identify who needs support and what kind of support will be most useful.

For more about ORC, visit, for example the Institute of Behavioral Research, Texas Christian University; for more about ORCA, see NHS Evidence.