Grand Canyon University Organizational Readiness Discussion

 reply to these 3 DQ

Karla:

Organizational readiness focuses on ability of a facility to make changes to structure or programming, in our case evidence-based practice training. The Marguerite Casey Foundation developed the Organizational Capacity Assessment Tool (OCAT) to help non-profits identify strengths and challenges regarding establishing capacity building. It is a diagnostic tool and helps members understand its abilities and opportunities for long-term growth. Highest ranking members of team should each complete an assessment, as well as lower ranking team members, helps to eliminate biases. The assessment is four parts: Leadership Capacity, Adaptive Capacity, Management Capacity, and Operational Capacity. After completing the assessment and it is completed as a self-assessment – two steps are needed, participants must rate the organization and prioritize capacity elements. Then those who completed the assessment have a discussion regarding the results (Marguerite Casey Foundation, n.d.).

Organizational Readiness for Knowledge Translation Tool (OR4KT) is the second tool I have chosen. OR4KT was developed after a large-scale review, expanding on Weiner’s original theory of organizational readiness for change (ORC) tool. There are three dimensions to this original tool, structural, psychological, and level of analysis. Structural and psychological dimensions have two levels while the third-dimension level of analysis focuses on using analysis of ORC in two other dimensions to preparation to change. OR4KT is different as the dimensions are motivation, leadership, change content, and organization change climate. These help the change agents evaluate for context. This tool was built and trialed in many countries and adapted to cultural climate (Puchalski Ritchie & Strauss, 2019).

These tools are similar in that they are rooted in readiness for change within an organization. OCAT focuses more on the non-profit sphere. OR4KT was developed with hospital setting in mind. OCAT is built for a more traditional work structure but does not seem to meet the intricacies of the hospital setting where there are multiple layers to the leadership and a differing chain of command structure amongst nurses. For this reason, I think that OR4KT tool would be best in assessing organizational readiness in my organization to implement a training program focused on building resilience amongst nursing staff.

Marguerite Casey Foundation (n.d.). Marguerite Casey Foundation Organizational Capacity Assessment Tool. Retrieved August 14, 2021 from: https://irp-cdn.multiscreensite.com/e8872eb0/files/uploaded/M.%20Casey%20Org.%20Capacity%20Assessment%20Tool%20%28paper%20version%29%202.pdf

Puchalski Ritchie, L. M., & Straus, S. E. (2019). Assessing Organizational Readiness for Change Comment on “Development and Content Validation of a Transcultural Instrument to Assess Organizational Readiness for Knowledge Translation in Healthcare Organizations: The OR4KT”. International journal of health policy and management, 8(1), 55–57. https://doi.org/10.15171/ijhpm.2018.101

Cristina:

Primary Care Transformation

There were four organizational assessment tools applicable to primary care, often connected with accrediting organizations. The National Council for Quality Assurance ([NCQA],n.d.) Patient Centered Medical Home Recognition Program (NCQA-PCMH) initiated in 2008, was the only resource that required a significant financial payment for access to its “PCMH Standards and Guidelines” document tool and was thus excluded as an option. The Agency for Healthcare Research and Quality ([AHRQ], n.d.)”Readiness Assessment for the TeamSTEPPS program” was readily available. The assessment questionnaire consists of twelve yes or no questions across five domains mostly directed at the institutional level of readiness, with broad application to multiple practice settings. The core concepts, competencies, and categories translate, however two assessment tools specific for primary care practice transformation were found to be more specific, validated, and robust both in content and resources. 

The two organizational readiness tools that were identified as most appropriate for assessing my organization were developed for primary care practice organizations were The PCPCH Self-Assessment tool (OHA, 2020) and The BBPCA assessment tool (UCSF Center of Excellence in Primary Care, n.d.), derived from the “Safety Net Medical Home Initiative PCMH-A assessment tool”(MacColl Institute, 2008). I have used all three tools in my practice transforming primary care since 2008 and have found I return to the BBPCA Assessment as the most accessible, teachable, and familiar. 

The first is the Oregon Health Authority (2020) “Patient Centered Primary Care Home (PCPCH) Self-Assessment Scoring Tool” and 2020 PCPCH Technical Assistance (TA) Guide. According to the OHA “The Oregon Legislature established the PCPCH Program in 2009 through passage of House Bill 2009 and the creation of a PCPCH Standards Advisory Committee. The goals of the program are to develop strategies to identify and measure what a primary care home does, promote their development, and encourage Oregonians to seek care through recognized Patient-Centered Primary Care Homes. The PCPCH Self-Assessment tool is a checklist of 35 Standards and additional sub-standards, including 11 must pass standards. Each Standard identifies the question type as progressive or all that apply, identifies if quantitative data is required to substantiate scoring. The maximum points available for each Standard and a calculated field based on scoring as the outcome to assess what PCPCH Tier level the practice may fall, with Tier One to Five Star, assigned by point scores and the base assumption that the 11 must pass Standards are met. In 2012, Oregon established the Patient Centered Primary Care Institute to support transformation efforts (n.d. In selecting which tool to utilize, the PCPCH Program checklist and TA Guide were centrically focused on the accreditation application process and data evaluation required rather than supporting the upstream transformation of primary care practice. In 2012, the Patient Centered Primary Care Institute (n.d.) was established as a resource to support, sustain, and spread PCPCH across Oregon. 

The second is the UCSF Center of excellence in primary care’s (2014)  “(Ten) Building Blocks of Primary Care Assessment (BBPCA)” survey. UCSF acknowledges that the BBPCA was derived from the public version of the “Patient Centered Medical Home Assessment (PCMH-A)” that was used in the 2008 Safety Net Medical Home Initiative (SNMHI)  by the MacColl Center for Health Care Innovation at Group Health Cooperative of Puget Sound (2014). The PCMH-A was extensively tested by 65 sites that participated in the initiative, including Federally Qualified Health Centers (FQHC) as well as other practices (MacColl Institute, 2014). The BBPCA is “designed to assess the organizational change of a primary care practice as measured against the 10 building blocks of a high performing primary care practice”(i). The BBPCA assessment uses a descriptive approach to take the user through each of the components that make up each building block and provided qualitative responses to match Levels D to A and Scores 1-12. The strength of the BBPCA is in the supporting documents to support the transformation process. It was validated at FQHC, where my proposed research project is targeted. The BBPCA also links back to the MacColl SNMHI website resources that include transformation practice examples, implementation guides for specific primary care clinical roles as well as practice change roles, governance, approaches, process guides, coaching guides, training tools, and forms to both support the transformation and sustain it(MacColl Center for Health Care Innovation, n.d.).

Doing this research anew has opened my eyes to the innovation and development of the body of knowledge that has been created to sustain and change to a culture of change and continuous process improvement for better health outcomes. The timing of my transition into nursing and primary care in 2008 has primed me with lived experience and opportunities to go through the implementation and accreditation process at both FQHC in which I served as a Nursing Manager and Practice Leader. I am grateful for the experience that motivated my current quest for a formal APRN advanced degree. 

References:

1. AHRQ (n.d.) TeamSTEPPS®: (National Implementation Research/Evidence Base) Assessment Tool. Tips and Suggestions for Enhancing Organizational Readiness. April 2016. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/teamstepps/readiness/abouttip…
2. National Council on Quality Assurance (NCQA).The PCMH Recognition Process. https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/process/
3. Oregon Health Authority (2020). Patient-Centered Primary Care Home Recognition Program. The PCPCH 2020 Recognition Standards Self-Assessment Tool. https://www.oregon.gov/oha/HPA/dsi-pcpch/Pages/become-recognized.aspx
4. Patient Centered Primary Care Institute (n.d.). About. https://pcpci.org/
5. UCSF Center for Excellence in Primary Care (n.d.). Tools for transformation. https://cepc.ucsf.edu/tools-transformation
6. UCSF Center for Excellence in Primary Care (2014). Building blocks of primary are assessment (BBPCA). https://cepc.ucsf.edu/sites/cepc.ucsf.edu/files/Building%20Blocks%20Assessment.pdf

Casey:

Change within an organization can happen at any given moment. However, it is appropriate to note what level of readiness an organization for a change to be accepted and adopted. The Change Curve Model suggest five different stages that organizations are in currently that can lead to their potential for success or failure of change (Melnyk & Fine-Overholt, 2019, pg. 428). The authors describe these stages as: 

·      Stagnation- more of a comfortable place or hyperactive. Action ends this stage (pg. 432)

·      Preparation- Exciting, sometimes barriers due to staff who resist change (pg. 433)

·      Implementation- Readiness and increasing confidence stage (pg. 433)

·      Determination-Change fatigue can occur, small successes? big deal (pg. 433)

·      Fruition-Positive outcomes are seen (Melnyk & Fine-Overholt, 2019, pg. 432-433)

This model is important for use in assessing my organization as it can provide insight on where I am in a state of change. 

A second model to assess for readiness is Lewin’s Change Theory model. This model is simple and is comprised of three phases, unfreezing, change, and freezing. “This theory, in its simplest form, suggests that first you need to prepare those who will change through a process of unfreezing their current view of the issue. Next, you must implement the change and, finally, freeze the new process into place” (DeNisco & Barker, 2016, pg. 73). 

These two models of change represent where an organization sits in regard to readiness of process change. Using the models one can make decisions on where the stakeholders are and if they are at a point of willing to change. One must then take the action, to ensure that the change is followed through, implemented correctly, and remain in place. 

In my professional opinion, these tools will be best to use in my current organization. This is due to the current morale of the team that I serve. The pandemic has taken a toll on everyone and it can be felt daily. I have a sense that any implementation of change will be resisted or not followed through carefully, as all the stakeholders are overwhelmed with job duties embedded into the pandemic.  

Reference:

DeNisco, S.M. & Barker, A.M. (2016). Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed). Jones & Bartlett.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Creating a vision and motivating a change to evidence-based practice in individuals, teams, and organizations. (Eds.), Evidence-based practice in nursing and Healthcare: A guide to best practice (3rd ed.), pp. 428-444 Wolters Kluwer.