摘要:
目的 实施性研究的成功执行受机构准备程度的影响。本研究旨在探索基层医疗机构实施"糖尿病共享门诊优化的实施性研究"项目(简称"SMART项目")的组织变革准备度(organizational readiness for change,ORC)和影响因素,进而为提高ORC,促进项目有效实施提供参考依据。方法 通过定性访谈和定量调查,采集实施SMART项目的12家机构的ORC水平及影响因素。通过机构实施循证实践的准备程度评估量表定量采集ORC水平;对变革执行者进行定性访谈,收集影响因素存在状态,利用主题分析法从访谈结果中提取影响因素条目,编制影响因素作用程度问卷,并采用该问卷收集变革执行者对影响因素作用程度的评估。采用模糊集定性比较分析(fuzzy-set qualitativecomparative analysis,fsQCA)方法确定影响因素对ORC的影响和良好ORC实施路径。结果 共12家SMART项目试点机构的70名变革执行者参与访谈和问卷调查,受访者包括机构管理者、临床医生和健康管理人员。ORC得分中位数为105.20(101.23,107.33)。fsQCA结果显示,了解具体任务和责任、具备关键人物、做好项目前期准备、制定评估与反馈是达到高水平ORC的路径。反之,缺少关键人物与前期准备两个核心条件,或其只发挥边缘作用时,将导致机构ORC水平较低。结论 实施变革前,变革执行者对变革的思想认同和认知参与程度是影响ORC的关键因素。关键人物的引领可有效促进变革准备度的提升,为后续提高实施保真度和成功率奠定基础。
Abstract:
Objective The success of implementation research is closely tied to the institution's pre-implementation readiness. This study aims to explore the organizational readiness for change (ORC) and its influencing factors on primary health care settings in the implementation of the "Shared Medical Appointment for Diabetes (SMART) in China:design of an optimization trial" and to enhance ORC and provide insights to support the effective implementation of the program. Methods Qualitative interviews and quantitative surveys were conducted to evaluate the ORC level and its influencing factors in 12 institutions implementing the SMART program. The Scale for Assessing the Institution's Readiness to Implement Evidence-Based Practices was utilized to measure ORC levels. Qualitative interviews were conducted among change implementers to gather information regarding the status of influencing factors. Thematic analysis was applied to extract factors from the interview data, and an assessment questionnaire was developed to measure the perceived impact of these factors. A fuzzy-set qualitative comparative analysis (fsQCA) method was employed to identify the influencing factors of ORC and pathways leading to high-level ORC. Results Seventy implementers from 12 institutions, encompassing administrators, clinicians, and health managers, participated in the interviews and surveys. The median and interquartile of the ORC scores were 105.20 (101.23, 107.33). The fsQCA indicated that a clear understanding of specific tasks and responsibilities, the active engagement of key participants, sufficient preliminary preparation, and the use of audits and feedback mechanisms were critical pathways to a high-level ORC. Conversely, institutions lacking key participants, preliminary preparation, or marginal influence demonstrated a low-level ORC. Conclusions Before implementing innovation, Coherence and Cognitive Participation were identified as critical factors in influencing ORC. Strong leadership from key participants played pivotal role in enhancing readiness for change and was essential for improving implementation fidelity and overall program success.
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