Development of an Instrument to Assess Organizational Readiness for Knowledge Translation in Healthcare

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This study aims to develop an instrument to evaluate organizational readiness for knowledge translation in healthcare, led by Marie-Pierre Gagnon (PhD) and Randa Attieh (PhD cand) from Laval University. It focuses on enhancing the dissemination of knowledge within healthcare settings to improve outcomes and practices.

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OR4KT: DEVELOPMENT OF AN INSTRUMENT TO ASSESS ORGANIZATIONAL READINESS FOR KNOWLEDGE TRANSLATION IN HEALTHCARE Marie-Pierre Gagnon (PhD) Associate Professeur, Laval University / Quebec University Hospital Centre Randa Attieh, PhD (cand) Community Health, Laval University marie-pierre.gagnon@fsi.ulaval.ca

Acknowledgement This study is supported by Knowledge Translation Canada, Canadian Institutes for Health Research and Canada Foundation for Innovation Project 2.2 Measuring organizational determinants of KT Research team: Carole A. Estabrooks (U Alberta) France L gar (U Laval) Jeremy Grimshaw (U Ottawa) Mathieu Ouimet (U Laval) Anne Sales (U Michigan) Collaborators: Gonzalo Grandes (Basque Health Service) Genevi ve Roch (U Laval) El Kebir Ghandour, Jenni Labarthe (PhD students) 2025-03-08 2

Background Incomplete implementation of evidence-based recommendations on optimal care into various clinical settings care context Difficulty to translate knowledge to the Prior to implement evidence-based interventions: Health-care organizations need sufficient high level of readiness Organizational readiness for change (ORC) is needed to assess: organization s readiness to implement evidence- based change in health care 3 2025-03-08

Background Lack of instruments specifically designed to assess OR for KT in health care No reliable and valid instruments found to assess the degree of readiness to implement evidence-based change 2025-03-08 4

Background Need to develop an evidence-based, valid and reliable instrument to: Measure OR for KT in health care Useful to support health care decision makers in their implementation of evidence-based interventions in real life settings 2025-03-08 5

Learning objectives Understand the different steps involved in the development and validation of the OR4KT instrument Identify key dimensions for assessing organizational-level factors that influence KT in healthcare Explore how the OR4KT instrument could be used in one s context 2025-03-08 6

Phase 1: OR4KT development process

Preliminary steps 1. Review and synthesize conceptual models/frameworks of ORC in healthcare 2. Development of a concept map as the basis for a comprehensive OR for KT framework 3. Review ORC measurement instruments that could apply to KT in health care. 4. Consensus on key dimensions and variables to assess the healthcare organizations readiness to implement evidence-based interventions 2025-03-08 8

Preliminary steps 10 theoretical models /conceptuel frameworks Systematic review of theories Systematic review of ORC instruments 26 eligible instruments 18 valid and/or reliable 5 core concepts Conceptual map 17 dimensions & 59 sub-dimensions Validity (4/4): TCU-ORC Reliability (2/3): TCU- ORC-D 6 dimensions & 24 sub-dimensions Modified Delphi study OR4KT development 2025-03-08 9

Phase 1: Results

5 key concepts Organizational dynamics Personal readiness Change process ORC Innovation Institutional readiness readiness

6 dimensions OR4KT Dimensions 1- Organizational climate for change 2- Organizational contextual factors 3- Change content 4- Leadership 5- Organizational support 6- Motivation

24 sub-dimensions OR4KT sub-dimensions 1- Organizational climate for change 1- Staff cohesion 2- Staff work-related stress 3- Communication about change 4- Manager s openness to change 4- Leadership 1- Leadership/Champion 2- Strategic planning process 3- Decision-making process 4- Adequate level of involvement 2- Organizational contextual factors 1- Appropriate human resources to support change 2- Appropriate material resources to support change 3- Organizational culture 5- Organizational support 1- Support climate 2- Monitoring 3- Evaluation process 4- Feedback 3- Change content 1- Attributes of change 2- Perceived complexity of change 3- Patient experiences and preferences 4- Research evidence supporting change 5- Clinical evidence supporting change 6- Motivation 1- Pressure for change 2- Training and education needs 3- Adequate knowledge and skills 4- Commitment

Initial instrument OR4KT instrument: 6 scales, 24 sub- scales Phase 1: Item identification Based on the original ORC instruments & our proposed items 97-items 13-02-2015 14

Phase 2: Validation of OR measures

Delphi for item selection Phase 1: Item selection International experts (14 1st; 10 2nd) Two-rounds Delphi questionnaire Panellists' agreement High agreement 70%: 91-items /97 OR4KT Long version (91-items) 13-02-2015 16

Validation of OR measures Phase 2: Content validity Relevance of the selected items to assess each of the sub-dimensions Panel expert recruitment: 7international experts in the fields of KT and/or ORC measurement 13-02-2015 17

Validation of OR4KT Phase 3: Item reduction Context: Spain (Primary care organizations) Respondents: 6 experts (2 physicians, 1 psychologist, 1 nurse, 1 manager, 1 researcher Items with < 80 % agreement removed OR4KT Short version (59-items) 13-02-2015 18

Validation of OR4KT Phase 4: Transcultural validation Develop Spanish and French versions of the OR4KT instrument Use of bilingual collaborators for the initial translation Professional translators for the back translation 13-02-2015 19

Validation of OR4KT Phase 4: Transcultural validation Original and back translated short and long versions for OR4KT were compared (Eng-Sp; Sp-Eng; Eng-Fr; Fr-Eng) Equivalence between Spanish and French translation and the original English version 13-02-2015 20

Phase 3: Field testing of the OR4KT

Administration of the OR4KT Short version of the OR4KT administered in an implementation project in the Basque Country Primary Care Service (G Grandes) 49 PC organizations targeted 13-02-2015 22

13-02-2015 23

Preliminary results 20 PHC centres (possibility of 5 additional) 126 individual respondents (physicians, nurses, managers) Between 4 and 7 participants per centre (mean score) Convergent and discriminant validity 13-02-2015 24

13-02-2015 25

OR4KT score in one region OR4KT Ezk-Enk 100 90 80 70 C1 60 C2 C3 50 C4 40 C5 C6 30 C7 20 10 0 Clima Factores contextuales Contenido cambio Liderazgo Apoyo Motivaci n organizacional organizacional 13-02-2015 26

IN PROCESS Validation of the OR4KT French short version Context: GMF Beauceville, Quebec Tool adaptation: Implantation du portail patient pour le suivi des soins chroniques Face validation:4 doctors, 2 administrative managers, 2 nurses 2025-03-08 27

NEXT STEPS OR4KT administration in Quebec Setting: 50 healthcare organizations in Quebec (Family medicine groups, private clinics, community centre) OR for electronic patient health portal (ePHP) implementation in primary care organizations in Quebec 28 2025-03-08

NEXT STEPS OR4KT administration in Ontario Setting: Potential use in the project Maternal Newborn Dashboard in Ontario (S Dunn) Potential for testing the English version (short or long) in other KT/implementation initiatives 29 2025-03-08

References Gagnon MP, Attieh R, Ghandour el K, L gar F, Ouimet M, Estabrooks CA, Grimshaw J. A systematic review of instruments to assess organizational readiness for knowledge translation in health care. PLoS One, 2014, 9 (12) :e114338 http://www.ncbi.nlm.nih.gov/pubmed/25474622 Attieh R, Gagnon MP, Estabrooks CA, L gar F, Ouimet M, Vazquez P, Nu o R. Organizational readiness for knowledge translation in chronic care: a Delphi study, BMC Health Services Research, 2014, 14: 534 http://www.biomedcentral.com/1472-6963/14/534 Attieh R, Gagnon MP, Estabrooks CA, L gar F, Ouimet M, Roch G, Ghandour EK, Grimshaw J. Organizational readiness for knowledge translation in chronic care: A review of theoretical components. Implementation Science 2013; 8.138 http://www.implementationscience.com/content/8/1/138 2025-03- 08 30