Table 1.

Organizational readiness to change assessment items

Scale	Sub-Scale	Items
Evidence*	Research	The proposed practice changes or guideline implementation:
		Are(is) supported by RCTs or other scientific evidence from the VA.
		Are(is) supported by RCTs or other scientific evidence from other healthcare systems.
		Should be effective, based on current scientific knowledge.
		Are(is) experimental, but may improve patient outcomes.
		Likely won't make much difference in patient outcomes**.
	Clinical Experiences	The proposed practice changes or guideline implementation:
		Are supported by clinical experience with VA patients.
		Are supported by clinical experience with patients in other healthcare systems.
		Conform to the opinions of clinical experts in this setting.
		Have not been attempted in this setting**.
	Patient Preferences	The proposed practice changes or guideline implementation:
		Have been well-accepted by VA patients in a pilot study.
		Are consistent with clinical practices that have been accepted by VA patients.
		Take into consideration the needs and preferences of VA patients.
		Appear to have more advantages than disadvantages for VA patients.
Context	Leadership Culture	Senior leadership/clinical management in your organization:
		Reward clinical innovation and creativity to improve patient care.
		Solicit opinions of clinical staff regarding decisions about patient care.
		Seek ways to improve patient education and increase patient participation in treatment.
	Staff Culture	Staff members in your organization:
		Have a sense of personal responsibility for improving patient care and outcomes.
		Cooperate to maintain and improve effectiveness of patient care.
		Are willing to innovate and/or experiment to improve clinical procedures.
		Are receptive to change in clinical processes.
	Leadership	Senior leadership/clinical management in your organization:
		Provide effective management for continuous improvement of patient care.
		Clearly define areas of responsibility and authority for clinical managers and staff.
		Promote team building to solve clinical care problems.
		Promote communication among clinical services and units.
	Measurement	Senior leadership/clinical management in your organization:
		Provide staff with information on VA performance measures and guidelines.
		Establish clear goals for patient care processes and outcomes.
		Provide staff members with feedback/data on effects of clinical decisions.
		Hold staff members accountable for achieving results.
	Opinion Leaders	Opinion leaders in your organization:
		Believe that the current practice patterns can be improved.
		Encourage and support changes in practice patterns to improve patient care.
		Are willing to try new clinical protocols.
		Work cooperatively with senior leadership/clinical management to make appropriate changes.
	Resources	In general in my organization, when there is agreement that change needs to happen:
		We have the necessary support in terms of budget or financial resources.
		We have the necessary support in terms of training.
		We have the necessary support in terms of facilities.
		We have the necessary support in terms of staffing.
Facilitation	Leaders' Practices	Senior leadership/clinical management will:
		Propose a project that is appropriate and feasible.
		Provide clear goals for improvement in patient care.
		Establish a project schedule and deliverables.
		Designate a clinical champion(s) for the project.
	Clinical Champion	The project clinical champion:
		Accepts responsibility for the success of this project.
		Has the authority to carry out the implementation.
		Is considered a clinical opinion leader.
		Works well with the intervention team and providers.
	Leadership Implementation Roles	Senior leadership/clinical management/staff opinion leaders:
		Agree on the goals for this intervention.
		Will be informed and involved in the intervention.
		Agree on adequate resources to accomplish the intervention.
		Set a high priority on the success of the intervention.
	Implementation Team Roles	The implementation team members:
		Share responsibility for the success of this project.
		Have clearly defined roles and responsibilities.
		Have release time or can accomplish intervention tasks within their regular work load.
		Have staff support and other resources required for the project.
	Implementation Plan	The implementation plan for this intervention:
		Identifies specific roles and responsibilities.
		Clearly describes tasks and timelines.
		Includes appropriate provider/patient education.
		Acknowledges staff input and opinions.
	Project Communication	Communication will be maintained through:
		Regular project meetings with the project champion and team members.
		Involvement of quality management staff in project planning and implementation.
		Regular feedback to clinical management on progress of project activities and resource needs.
		Regular feedback to clinicians on effects of practice changes on patient care/outcomes.
	Project Progress Tracking	Progress of the project will be measured by:
		Collecting feedback from patients regarding proposed/implemented changes.
		Collecting feedback from staff regarding proposed/implemented changes.
		Developing and distributing regular performance measures to clinical staff.
		Providing a forum for presentation/discussion of results and implications for continued improvements.
	Project Resources	The following are available to make the selected plan work:
		Staff incentives.
		Equipment and materials.
		Patient awareness/need.
		Provider buy-in.
		Intervention team.
		Evaluation protocol.
	Project Evaluation	Plans for evaluation and improvement of this intervention include:
		Periodic outcome measurement.
		Staff participation/satisfaction survey.
		Patient satisfaction survey.
		Dissemination plan for performance measures.
		Review of results by clinical leadership.

* The Evidence questions are preceded by a statement identifying the evidence-based practice that is the current target of intervention.

** Denotes items that are reverse coded.