What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP)
What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP)
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DOI：
10.1007/s00520-020-05836-9
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发表时间：
2020-10-23
影响因子：
3.1
通讯作者：
Rankin, N. M.
中科院分区：
文献类型：
--
作者：
Geerligs, L.;Shepherd, H. L.;Rankin, N. M.
将循证心理肿瘤干预转化为常规护理可以显着改善患者的预后，但由于现实世界中存在许多障碍，有效实施仍然具有挑战性。可能影响实施的一个关键因素是组织对变革的准备情况。这项混合方法研究旨在确定与实施澳大利亚临床路径的组织准备相关的因素，该路径用于成年癌症患者的焦虑和抑郁的筛查，评估和管理（ADAPT CP）。方法：我们收集了来自澳大利亚6个癌症服务机构的多学科工作人员的数据，他们正准备实施ADAPT CP。服务被归类为具有“高”与“中档”的组织准备的基础上，对实施变革（ORIC）问卷的组织准备的中位数分裂（分数范围= 12-60）。从半结构化访谈的基础上促进行动研究在卫生服务（PARiHS）框架的定性数据进行了专题分析，并与高与中档的组织准备的服务进行了比较。结果三个服务高（平均ORIC范围，52.25-56.88），和三个中档（范围，38.75-46.39）的组织准备得分被确定。报告准备程度较高的服务工作人员描述了一种更具协作性和主动性的服务文化，强大的沟通流程和更大的角色灵活性。他们还报告说，对克服预期障碍的信心有所增强，解决问题的战略也更加明确。结论组织准备程度与不同的定性主题有关。在全面推出之前，针对准备程度为中等或较低的服务中的这些问题，可以提高工作人员在实施以心理肿瘤学为重点的干预措施时的信心和效力。
Aims Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). Methods We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. Results Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. Conclusions Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.