Health care professionals' readiness for an interprofessional orthogeriatric unit: A cross-sectional survey

Abrahamsen, C. (Oplægsholder), Nørgaard, B. (Underviser), Draborg, E. (Underviser)

Aktivitet: Foredrag og mundtlige bidragKonferenceoplæg


Oral presentation at the ‘world cafe style’ interactive session

1) Introduction:
It is well attested that interprofessional collaboration can strengthen health care systems and improve health outcomes (1, 2). In the light of the beneficial patient outcomes and improved quality, many hospital managers are considering a change from traditional specialised orthopaedic care to an orthogeriatric interprofessional care model. However, for organizational changes to succeed, staff members must be ready (3, 4). Thus, an assessment of readiness for change can set the stage for implementation by providing information regarding staff members' beliefs and attitudes prior to an organizational change. The aim of this study was to assess readiness for change among staff members prior to the launch of an orthogeriatric unit.

2) Methods:
We designed as a cross-sectional questionnaire survey to be carried out between one and two months prior to the launch of an orthogeriatric unit. Healthcare professionals from the departments of medicine, orthopaedic surgery, and therapy who were considered to have a professional link with orthogeriatric patients in terms of treatment or administration were included in the survey.
The questionnaire was based on Kristensen and Nohr´s theory-driven and validated questionnaire assessing readiness for change among Danish healthcare professionals (5), and adjusted to accommodate conditions of orthogeriatric care. Minor adjustments were made after face validation and pilot testing.
Our final questionnaire included six items assessing background information and 25 items covering four subthemes: 1) knowledge and understanding; 2) need for change; 3) readiness for change (10 items); and 4) planning for change. The questionnaire was distributed by e-mail to be responded online.
To examine the professional groups’ readiness for change (ten items), item scores from 0–5 were generated, with 5 for the most positive response (fully agree), 1 for the most negative response (fully disagree), and 0 for the don’t know option.
The data on professional background were collapsed into four groups: 1) physicians (consultants and registrars), 2) care group (nurses and nursing assistants), 3) therapists (physiotherapists and occupational therapists) and 4) a small group of secretaries, dieticians and managers without patient contact.

3) Results:
Fully completed questionnaires were returned by 113 respondents (50.7%); the response rate among physicians was 49.2% and 51.2% for the other groups.
The healthcare professionals indicated good knowledge of and strong support for the decision to implement an orthogeriatric unit; 77.9% of respondents indicated that they had either excellent knowledge or some knowledge of orthogeriatric care, and 87.6% expressed their full support or support for the creation of the orthogeriatric unit.
The respondents described the motivating factors for orthogeriatric care as expectations of improvement in areas such as patient treatment and patient-perceived quality, the organization of clinical pathways, and interdisciplinary collaboration. In fact, 91.2 stated that orthogeriatric care would have a positive effect on quality in patient treatment, 77.0% that it would have a positive effect on patient-perceived quality, 68.1% believed it would improve the organization of the clinical pathway, while 77.9% expected it to significantly promote the interdisciplinary approach. Furthermore, 88.5% of the responding healthcare professionals indicated a belief that orthogeriatric care would match the hospital’s need for change.
However, the care group expressed some concerns regarding work-related interests and work strain: 58% expressed the belief that no work-related interests would be threatened and 46% expected a positive effect on the working environment; the lowest score compared to the other groups and weaker than average.
The overall readiness for change furthermore varied between healthcare professions: the median score was lowest in the care group (median 3.7), followed by the therapists (4.0), other professions (4.3) and physicians (4.4)—indicating that physicians and professionals without patient contact tended to feel more ready for the implementation than did nurses and therapists (p = 0.1; Figure 1).
As the group of physicians included both orthopaedic surgeons and medical doctors, readiness for change was assessed within the group of physicians. The median was found to be 4.5 for surgeons and 3.4 for medical doctors, indicating that the former group was more ready for change to orthogeriatric care than were their medical colleagues (0.0057; Figure 2).

4) Discussion:
We found that, the majority of healthcare professionals expressed good knowledge, strong support, and a high readiness for change. Furthermore, they expressed positive expectations for future orthogeriatric care in terms of improved patient treatment and patient-perceived quality, as well as for improvements in the organization of clinical pathways and interdisciplinary collaboration. All of the mentioned factors testify to the staff’s commitment to the decision to implement an interprofessional collaboration model, which is an essential element of successful organizational change (4). The gender and age distributions of our respondents were similar to those of the entire study population, although their employment had lasted longer. While some evidence suggests that relatively new recruits to an organization tend to be more ready for change (6), others have found no correlation between readiness for change and years in present job (7, 8).
The exploration of readiness for organizational change among health care professionals offers managers an understanding of their motivations and concerns and provides a useful tool in their planning and implementation of a new interprofessional collaboration model.

5) References
1.Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. The Cochrane database of systematic reviews. 2011(7):Cd006211.
2.Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L. Systematic review of multidisciplinary interventions in heart failure. Heart. 2005;91(7):899-906.
3.Weiner BJ. A theory of organizational readiness for change. Implementation science : IS. 2009;4:67.
4.Hamilton AB, Cohen AN, Young AS. Organizational readiness in specialty mental health care. J Gen Intern Med. 2010;25 Suppl 1:27-31.
5.Kristensen M, Nohr C. Technological changes in the healthcare sector. A method to assess change readiness. Studies in health technology and informatics. 2000;77:259-63.
6.Hanpachern C, Morgan GA, Griego OV. An extension of the theory of margin: A framework for assessing readiness for change. Human Resource Development Quarterly. 1998;9(4):339.
7.Madsen SR, Miller D, John CR. Readiness for organizational change: Do organizational commitment and social relationships in the workplace make a difference? Human Resource Development Quarterly. 2005;16(2):213.
8.Shah N, Shah SGS. Relationships between employee readiness for organisational change, supervisor and peer relations and demography. Journal of Enterprise Information Management. 2010;23(5):640-52.

6) Declaration of competing interests
The authors declare that they have no competing interests.

Periode2. maj 20184. maj 2018
BegivenhedstitelInternational Forum on Quality and Safety in Healthcare: null
PlaceringAmsterdam, Holland