Organizational Readiness for Evidence-Based Practice in Nursing

Introduction

We are living in a century that demands an accelerated rate of progress in healthcare. Advancements in healthcare organizations are not constant, and it is therefore critical to an organization's success that it maintains the ability to change its usual ways of practice. Change manifests across different dimensions — political, social, and financial — and an organization's tendency to adapt to change is a key indicator of its success (Diab, Safan & Bakeer, 2017). When an organization moves from its current state to a more desirable future state, this is referred to as organizational change. Organizational change management involves the preparation and application of both positive and negative changes within the organization, carried out in a way that reduces employee resistance and organizational cost while strengthening tolerance for change efforts. It is therefore advisable for people to prepare for change in order to reduce resistance to it (Vakola, Oreg & Armenakis, 2013).

Change is more likely to take place when those who embrace it outnumber those who oppose it. This is reflected in the model for individual and organizational change. The willingness of an individual to pursue therapeutic change originally informed the transtheoretical model in psychotherapy. In an effort to prepare stakeholders for change, the transtheoretical model emphasizes the need to remove obstacles to the change initiative and to cultivate the desire for change by introducing motivators — which may be either psychological or structural (Howley, 2012).

The following guidelines can help identify the best approach to change by breaking the process down from the status quo to the future state in five stages:

1. Craft the change
2. Plan the change
3. Put the change into effect
4. Manage the change
5. Sustain and maintain the change (Cavarec, 2014).

Failure by top management to support nursing staff at lower levels can be one of the primary barriers to change. Poor pay and lack of rewards, inadequate facilities and resources, insufficient information about the need for change, and the absence of staff training programs are all factors that impede change. Consequently, there is likely to be a lack of commitment, dissatisfaction, and reduced motivation among nursing staff to participate in change initiatives (El-Sayed, Seada & El-Guindy, 2017).

Managing change is clearly a complex process. It is also difficult to characterize and initiate in a rapidly changing world marked by diversity across cultures, ecologies, and organizational missions. Since leaders are obligated to make sound decisions and implement their conclusions, the guidance provided by theories of change is undoubtedly useful to them. Leaders can use models of change to prepare their organizations to adopt fresh methods of embracing change and achieving their objectives. Change management may be a more intricate skill than conventional science, as the ambiguity in current research on the topic underscores. Insights from practice are therefore invaluable to such leaders (Howley, 2012).

According to Jones et al. (2005), employees' perceptions of organizational culture are shaped by their fundamental human perspective. An organization with open relational values will be associated with higher levels of readiness for change, which in turn predicts the success of implementation. Analysis revealed that pre-implementation levels of readiness for change had a positive impact on employee satisfaction, given a system that is error-free and user-friendly. In a related study by Ingersoll et al. (2000), the relationships among organizational commitment, organizational culture, and organizational preparedness were examined in a group of employees participating in a hospital-wide redesign process. Results showed that when change is received positively, employees tend to invest greater effort and commitment in their institution's work. According to Treuer et al. (2018), an organization's overall readiness for change depends significantly on modifications to its organizational climate and leadership style.

Literature Review

This research was conducted to address the following problem statement: "What is the level of readiness of my organization's staff for evidence-based practice?" To determine how ready the organization was to incorporate evidence into practice, this study sought the opinions of nurse managers and staff nurses regarding the implementation of evidence-based practice (EBP) changes. It also examined the barriers that hinder the incorporation of practice changes.

Change readiness assessment seeks to evaluate readiness across three main dimensions: the circumstances, the individual approach, and the available resources in a system — assessed at all levels (Diab et al., 2017). The Prevention Program Assessment (PPA) tool will be used to evaluate how ready healthcare employees are to implement evidence-based practice. The tool was originally developed to assess organizational preparedness for evidence-based interventions in programs related to the prevention of chronic diseases, including asthma, obesity, and diabetes, among others. It can be particularly useful for public health practitioners who want to gauge their organization's readiness to launch evidence-based programs.

The tool comprises 23 questions across four categories: awareness, adoption, implementation, and maintenance. These are designed to guide users in evaluating a given organization's preparedness to apply evidence-based practice in both private and public health settings. The Prevention Program Assessment tool employs four basic stages for readiness assessment (Stamatakis et al., 2012):

Problem Statement and Methodology

1. Awareness: Assessing community and organizational awareness, and recognizing the availability and need for sources of evidence-based interventions (EBIs).
2. Adoption: Analyzing the extent to which evidence is used in decision-making.
3. Implementation: Implementing and adapting the intervention to fulfill community needs.
4. Maintenance: Ensuring the availability of resources and activities for the ongoing support of the innovation.

These four stages make the Prevention Program Assessment Tool a worthwhile instrument. It caters to both senior and junior staff, making it appropriate for this project. It should be used both at the beginning of training (pre-intervention) and after training (post-intervention). The training will cover, among other things, division of labor, discipline, decision-making, fair leadership, sustainable employment, comprehensive instruction, remuneration, and performance appraisal. The four stages span a period of six months, after which preparedness for change is re-evaluated using the tool (Cavarec, 2014).

The tool has been tested through interviews with samples representing study areas in chronic disease prevention. The degree of readiness was measured using confirmatory factor analysis (CFA). CFA was first applied to an initial four-factor model of organizational preparedness and was subsequently adapted using several model-fit indices, including the comparative fit index, chi-square/degrees of freedom, a 90% confidence interval, and root mean square error of approximation. CFA proved most appropriate for the 5-point scales of adoption and implementation and considerably improved the awareness and maintenance scales. The maintenance scale was further divided into four- and five-item scales: the four-point scale represents evaluation maintenance, while the five-point scale represents resource maintenance. The final scales demonstrated good fit, with factor loadings between 0.40 and 0.60. The readiness scale was also found to be sound, with ranges from 0.47 to 0.71 (Stamatakis et al., 2012).

This study will be conducted in healthcare centers and hospitals. Potential participants include hospital managers and registered nurses (RNs). Convenience sampling will be used for participant selection. All participants will be required to sign a consent form before taking part in data collection.

A non-randomized sample of registered staff nurses and nurse managers from acute and critical care units will be included. The objectives of the study will be explained to managers, who will then be asked to provide consent for the research to proceed. A cover letter will accompany the survey to provide additional information to staff. Approval will be sought from the hospital's Human Subjects Research Committee, and the researcher will ensure informed consent is obtained. Participant confidentiality will be maintained throughout. The PPA tool will be administered before the commencement of training; after the six-month training period concludes, it will be administered again to the same subjects. The difference in responses between the two time points will provide information about readiness for change.

The effort by nurses to improve nursing education, the profession, or patient care for the overall transformation of healthcare is captured by the term leading change (Nelson-Brantley & Ford, 2016). Many interventions intended to improve outcomes are most likely to succeed when they address the core practice determinants for improvement within the targeted setting. Implementation research has historically focused on individual-level practitioners (Bosch et al., 2016). It is possible to conduct pre- and post-evaluations with an effective intervention. The readiness of nursing staff to change can be measured with the Prevention Program Assessment Tool (Stamatakis et al., 2012) at the onset of an intervention.

Performance is essentially measured by gathering relevant data that reflects how well a program is performing. One commonly used strategy is pre-post analysis, which involves assessing participants both at the program's start and at its conclusion. A notable difference between the two assessments suggests that the program has meaningfully benefited participants (Tatian, 2016). This research will employ a similar approach. The differences observed between the two assessment points serve as a good indicator of whether the organization's goals and objectives have been adequately met.

The following strategies may prove useful during the training sessions:

Authority and discipline. The tiered relationship between managers and employees within an organization, with delegation flowing from the top downward.

Centralized decisions. Major decisions are made at the top. The head directs while others execute. Disagreements are resolved by the manager.

Conclusion and Limitations

The healthcare sector requires a continuous focus on leadership traits even as leaders endeavor to implement other priorities such as climate change concerns. For instance, leadership training could be implemented alongside climate policies, enabling leaders to uphold evidence-based leadership behaviors while applying their implementation capabilities, thereby creating strategic climates conducive to change.