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Organizational Readiness to Change Assessment (ORCA)

Organizational Readiness to Change Assessment (ORCA). National QUERI Meeting December 11, 2008 Christian D. Helfrich, MPH, PhD Implementation Research Coordinator IHD-QUERI. ORCA. Organizational readiness to change assessment 77-item survey instrument

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Organizational Readiness to Change Assessment (ORCA)

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  1. Organizational Readiness to Change Assessment(ORCA) National QUERI Meeting December 11, 2008 Christian D. Helfrich, MPH, PhD Implementation Research Coordinator IHD-QUERI

  2. ORCA • Organizational readiness to change assessment • 77-item survey instrument • Fielded among clinicians and staff involved in planned, discrete clinical change projects • Measures factors that determine effective implementation of a practice change

  3. ORCA Development • Developed by Nancy Sharp and Anne Sales, Ischemic Heart Disease Quality Enhancement Research Initiative • Based on Promoting Action on Research Implementation in Health Services (PARIHS) framework

  4. ORCA Evidence Organizational to change Implementation outcomes Context Facilitation

  5. Evidence Scale Discord over evidence Evidence Research Practice experience Organizational to change Context Patient experiences Facilitation

  6. ORCA Leadership culture Evidence Staff culture Opinion leader culture Organizational to change Context Leadership practice Evaluation / Accountability Facilitation Slack resources

  7. ORCA Leadership roles in planning Evidence Project champion roles Leadership roles in support Organizational to change Context Implementation team roles Assessment Facilitation Evaluation Implementation plan Communication Project resources

  8. Scoring the ORCA • Each subscale measured with between 3 – 6 items • Items are statements • Respondents rate level of agreement from 1 (strongly disagree) to 5 (strongly agree) • Subscales are calculated as average of items; scales as average of subscales • Higher scores indicate greater likelihood of success.

  9. Preliminary validation • Three quality improvement (QI) projects (n = 113): • 1) The Cardiac Care Initiative (n = 65 from 49 facilities); • 2) The Lipids Clinical Reminders project (n = 12 from 1 facility) • 3) An intensive care unit quality improvement project (n = 36 from 9 facilities) • Identical surveys administered to one or more staff involved in quality improvement efforts; • Only the initial evidence statement varied, identifying the evidence-based practice change.

  10. ORCA scale reliability

  11. Content validation • Exploratory factor analysis • 3 retained factors (eigenvalues 7.61, 7.12, 3.23)

  12. Principal components analysis

  13. Validation Conclusions • Overall good reliability and content validity of the three scales • Poor reliability of the evidence subscales • Slack resources may be separate factor • Facilitation subscale measuring leadership roles in planning, may be part of context scale; may need rewording

  14. Next Steps • Submitted grant to conduct further validation • Collaborating with three implementation projects by Mental Health and Spinal Cord Injury QUERIs to assess predictive validity • Develop user’s manual and Web-based, customizable version • Work with partners to produce example cases of how to use organizational readiness assessments to guide implementation projects

  15. References • Helfrich C, Li Y-F, Sharp ND, Sales A. Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARiHS) framework. Implementation Science. Under review.

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