Table 4.

Factors enhancing and hindering readiness for change

	Factors that Enhance Readiness	Factors that Hinder Readiness	Differences Between Managers and Health care Providers
Discrepancy	-Encountering challenges with the status quo of health service delivery with the Senior Care Program	-Limited awareness of problems associated with the current state	-Discrepancy experienced similarly by frontline providers and middle managers
Appropriate-ness	-Detailed knowledge about the Health Links approach	-Perception that Health Links is a duplication of the Senior Care Program -Poor rapport with Senior Care Program management at the Lead Site	-Newer employees and middle managers were more likely to view the integration as appropriate when compared to other providers
Valence	-Seeing value to Health Links at the system and the patient level	-Perception of increased workload with the implementation of Health Links (e.g., double documentation)	- Frontline providers mostly discussed benefits of the integration at the patient level and managers discussed the benefits of the integration at the health system level
Self-Efficacy	-Informal training (e.g. job shadowing) -Learning by doing	-Formal training not comprehensive enough (focused on limited aspects of Health Links) -Lack of training on change management	-Self efficacy experienced similarly by frontline providers and middle managers -Middle managers emphasized the need for training on change process and management
Fairness	-Working at sites with more administrative support and more opportunities for training	-Not being consulted on the change -Working at sites with minimal opportunities for training and no administrative support	-Lack of procedural and distributive fairness experienced similarly by frontline providers and managers
Trust in management	-Clear communication from local managers -Local managers’ ability to support and provide solutions	-Limited or unclear communication from managers at higher levels -Leadership ambiguity -Not knowing who to turn to for information or support	-Trust in management experienced similarly by frontline providers and middle managers. -Lead Site managers themselves viewed contact with and information from their superiors as lacking