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UBC Theses and Dissertations

The importance of organizational readiness for change for implementing clinical practice standards in Indonesian obstetric facilities Laugen, Christian Myers


Background: Quality improvement initiatives require collective and coordinated actions from multiple members of a health care organization. Preparing health workers prior to implementation by assessing their organizational readiness for change (ORC) may be effective for ensuring greater implementation success. Although common in other fields, measuring readiness in health organizations is less common, especially in lower- and middle-income countries (LMIC). This study aims to assess ORC in multiple Indonesian hospitals prior to implementation of a maternal and newborn quality improvement program. Methods: The Organizational Readiness for Change Assessment (ORCA) measurement tool based on the Promoting Action on Research in Health Services (PARIHS) was adapted to the Indonesian context, then internal reliability and factor structure of the primary scales was examined: evidence, context, and facilitation. The Indonesian version of the instrument was administered to respondents in hospitals prior to engagement in program implementation (n=36). Then linear regression analyses were conducted to examine associations between hospital level ORC scores and multiple outcomes of program implementation success, including performance of maternal and newborn clinical standards and provision of related services while adjusting for education level, clinical experience, and leadership experience. Results: Cronbach alpha for the three scales was 0.72, 0.94, 0.97, respectively; confirmatory factor analysis showed good fit for models including items on each of the three scales. The ORCA context scale was positively associated with performance of two maternal clinical standards. A higher ORCA context score was associated with greater implementation of active management of the third stage of labor after one and two implementation quarters (beta = 27.35, 95%CI 1.27, 53.44; beta = 27.71, 95%CI 3.29, 41.59). A higher ORCA context score was also associated with greater implementation of management of severe pre-eclampsia/eclampsia after two and three implementation quarters (beta = 37.46, 95%CI 13.52, 61.41; beta =33.31, 95%CI 8.68, 57.94). Conclusion: This study confirmed the reliability and validity of the ORCA instrument in a middle-income country and added evidence for the utility of assessing ORC prior to quality improvement initiatives in healthcare environments. Health care organizations in LMICs may improve the likelihood of success by addressing ORC prior to program implementation.

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