Organizational Readiness for Change Depends on Facility Complexity When Developing a National Stewardship Intervention

• Published in: Antimicrobial Stewardship & Healthcare Epidemiology
• Main Authors: Eva Amenta, Larissa Grigoryan, Sophia Braund, David Ramsey, John Donnelly, Rogelio Hernandez, Aanand Naik, Barbara Trautner
• Format: Article in Journal/Newspaper
• Language: English
• Published: Cambridge University Press 2024
• Subjects: Infectious and parasitic diseases; RC109-216; Public aspects of medicine; RA1-1270; Orca
• Online Access: https://doi.org/10.1017/ash.2024.163; https://doaj.org/article/45f973d64c724374bedabc3697ee11a7

Introduction: The organizational readiness for change assessment survey (ORCA) is a tool to assess a site’s readiness for implementation and identify barriers to change. As the “Kicking CAUTI” antibiotic stewardship intervention rolled out on a national scale, we administered ORCA surveys to participating sites to capture baseline actionable information about differences among sites, to inform implementation. Methods: ORCA surveys were distributed by email to prescribing providers, nurses, pharmacists, infection preventionists, and quality managers at 40 participating VA Hospitals. VA hospital sites who submitted three or more surveys and their complexity level (measured as Level 1 (highest)-3) were included in the analysis. The highest complexity level facilities are those with the largest patient volume/risk, teaching and research, along with the largest number of physician specialists and contain at least five ICUs. Mean Likert scores were calculated for each of the 7 ORCA subscales on a scale of 1-5 (5 highest), and the mean of the 7 subscales was the overall ORCA score for a site. Non-parametric testing was performed comparing overall ORCA and each subscale based on complexity. Results: Among the participating sites, 30/40 (75%) completed at least three surveys, with a total of 202 surveys included for analysis, with 82% of surveys coming from higher complexity centers (Level 1). The highest ranked ORCA domain was the evidence subscale (measures perceived strength of evidence), mean 4.2, (SD 0.7). The lowest ranked ORCA domain across sites was resources (available to facilitate implementation), mean 3.3 (SD 0.9). Higher complexity centers had a significantly higher overall ORCA score than lower complexity centers (Level 1 or 2 vs. Level 3, p= 0.02). This difference was driven by the subscales evidence (p < 0 .01), leadership (p =0.05), measurement (p= 0.06), and resources (p=0.07) all being higher in the higher complexity facilities (Figure 1). Two of the categories (leadership and measurement) pertain ...