Predicting Successful Implementation of Practice Initiatives in a Magnet Organization using the Organizational Readiness to Change Assessment

Sunday, 17 November 2013: 2:45 PM

Kelly E. Lancaster, RN, MSN, CAPA
Dept of Nursing, Ambulatory Surgery Center, Brighton Campus, Maine Medical Center, Portland, ME
Kristiina Hyrkas, PhD, LicNSc, MNSc, RN
Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, ME
Gertrude Kent, RN, BSN
Maine Medical Center, Portland, ME
Debbie Michaud, RN
Department of Patient Care Services, Maine Medical Center, Portland, ME

Learning Objective 1: 1. The learner will be able to describe how the Organizational Readiness to Change Assessment (ORCA) may be used to evaluate evidence-based practice implementation.

Learning Objective 2: 2. The learner will be able to identify differences between groups with high facilitation and low sustainability versus low facilitation and high sustainability characteristics.

Background:  The Organizational Readiness to Change Assessment (ORCA) measures readiness for successful implementation of evidence-based practice changes. Organizations may support innovation, but the context and cultures of clinical units may not reflect that support, affecting the success of practice implementation. The purpose of this study was to examine the predictive validity of the ORCA by comparing the scores of two groups of nurses demonstrating high sustainability in the use of buffered lidocaine as local anesthesia for IV catheter insertion with the scores of nurses demonstrating low sustainability. 

Methods:  RNs (n=109) from eight clinical units within a 605 bed tertiary medical center participated in this exploratory study.  Units were chosen based on previous quality improvement data regarding the sustainability of the evidence-based practice initiative. The intervention group (1), consisting of 4 nursing units,  received high facilitation (education) to encourage the use of intra-dermal lidocaine, but showed low rates of sustainability. The control group (2), also consisting of 4 nursing units, did not receive high facilitation, but demonstrated high sustainability. 

Results: Both Linear and Logistic Regression analyses identified the ORCA model variables of evidence assessment (t=-6.30, P<.001), context assessment (t=2.41, p=.0192), and implementation plan (t=2.06, p=.0435) to be significant predictors of successful practice implementation. These three variables accounted for 46.28% of the fitted model (R-Square = 0.4628). The t-test was used to compare the intervention group (1) with the control group (2). Results showed that group 2 (low facilitation/high sustainability) had significant differences with clinical experience (t=-3.92, p=.000), perceptions of patient preference (t=-2.51, p=.014), and staff member culture (t=-2.02, p=.046) compared to group 1. 

Conclusions & Implications: Good predictive validity was shown with the three model variables. The results of the study suggest that ORCA was able to identify differences in groups relative to the facilitation of an evidence based practice initiative.