Organizational readiness for knowledge translation in chronic care: a Delphi study

Attieh et al. BMC Health Services Research 2014, 14:534 http://www.biomedcentral.com/1472-6963/14/534 RESEARCH ARTICLE Open Access Organizational readiness for knowledge translation in chronic care: a Delphi study Randa Attieh1, Marie-Pierre Gagnon1,2*, Carole A Estabrooks3, France Légaré1,4, Mathieu Ouimet1,5, Patricia Vazquez6 and Roberto Nuño6 Abstract Background: Health-care organizations need to be ready prior to implement evidence-based interventions. In this study, we sought to achieve consensus on a framework to assess the readiness of health-care organizations to implement evidence-based interventions in the context of chronic care. Methods: We conducted a web-based modified Delphi study between March and May 2013. We contacted 76 potentially eligible international experts working in the fields of organizational readiness (OR), knowledge translation (KT), and chronic care to comment upon the 76 elements resulting from our proposed conceptual map. This conceptual map was based on a systematic review of the existing frameworks of Organizational Readiness for Change (ORC) in health-care. We developed a conceptual map that proposed a set of core concepts and their associated 17 dimensions and 59 sub-dimensions. Experts rated their agreement concerning the applicability and importance of ORC elements on a 5-point Likert scale, where 1 indicates total disagreement and 5 indicates total agreement. Two rounds were needed to get a consensus from the experts. Consensus was a priori defined as strong (≥75%) or moderate (60-74%). Simple descriptive statistics was used. Results: In total, 14 participants completed the first round and 10 completed the two rounds. Panel members reached consensus on the applicability and importance of 6 out of 17 dimensions and 28 out of 59 sub-dimensions to assess OR for KT in the context of chronic care. A strong level of consensus (≥75%) was attained on the Organizational contextual factors, Leadership/participation, Organizational support, and Motivation dimensions. The Organizational climate for change and Change content dimensions reached a moderate consensus (60-74%). Experts also reached consensus on 28 out of 59 sub-dimensions to assess OR for KT. Twenty-one sub-dimensions reached a strong consensus (≥75%) and seven a moderate consensus (60-74%). Conclusion: This study results provided the most important and applicable dimensions and sub-dimensions for assessing OR-KT in the context of chronic care. They can be used to guide the design of an assessment tool to improve knowledge translation in the field of chronic care. Keywords: Organizational readiness, Delphi study, Knowledge translation, Chronic care, Measurement Background Health-care organizations need sufficient high levels of readiness prior to implement evidence-based interventions [1,2]. Organizational readiness for change (ORC) in health-care settings is needed to assess an organization’s readiness to implement change in health-care in * Correspondence: 1 Research Centre of the Centre Hospitalier Universitaire de Québec, Hôpital St-François d’Assise, 45 rue Leclerc, Quebec City, QC, Canada 2 Faculty of Nursing, Université Laval, Quebec City, QC, Canada Full list of author information is available at the end of the article general [3,4] and in chronic care in particular [5]. ORC is a broad concept that encompasses other concepts found in the literature, such as organizational capacity [6]. Although there have been several attempts at measuring organizational readiness [7], a limited number of valid and reliable measurement tools to assess the degree of readiness to implement evidence-based change is available [3,8]. In previous work, we reviewed and synthesized the existing evidence on conceptual models/frameworks of ORC as the basis for the development of a comprehensive © 2014 Attieh et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Attieh et al. BMC Health Services Research 2014, 14:534 http://www.biomedcentral.com/1472-6963/14/534 framework of organizational readiness (OR) for knowledge translation (KT) in the context of chronic care (CC) [6]. The focus was to understand OR components relevant to KT for CC interventions. The context of CC was chosen because the research project aims to contribute to advance conceptual and measurement developments in this particular field. CC services will serve as an exemplar in order to validate the instrument that we aim to develop at the end of this project. The selection of relevant theories and frameworks was thus made on the basis that they would be relevant to KT for CC interventions and eventually, KT for other types of interventions. The 10 theories, theoretical models and conceptual frameworks that we identified often reflect a narrow view of readiness and omit one or more conceptual elements that are important for a comprehensive assessment of ORC [6]. After graphically analyzing the different components of OR gathered from these 10 theories, theoretical models and conceptual frameworks, the conceptual map allowed us identifying five core concepts common to the operationalization of OR for KT [6]. We also highlighted the relationships between the concepts, dimensions and sub-dimensions included in these models and frameworks. This conceptual map enables us to identify 17 dimensions and 59 sub-dimensions potentially important to consider for assessing OR for KT in health-care organizations [6]. The review and the tentative conceptual map provided a useful overview for researchers interested in ORC in general, and of OR for KT in CC in particular. In this Delphi study, we sought to achieve consensus on a framework to assess the readiness of health-care organizations to implement evidence-based interventions in the context of chronic care. Page 2 of 12 on ORC elements resulting from the literature review and concept map. Participants recruitment and inclusion criteria A two-round web-based Delphi technique was applied in order to reach consensus among international experts on dimensions and sub-dimensions of a framework to assess OR for KT in CC. Target participants included experts in the fields of organizational readiness, chronic care, and knowledge translation, and were identified from their contribution to the literature in these domains and from our personal contacts. A total of 78 experts were emailed an invitation letter soliciting their participation in the research project. The letter provided a brief outline of the project, its objectives, the expected number of roun (...truncated)