Organizational readiness for implementation: a qualitative assessment to explain survey responses

Background: One factor considered essential to successful implementation is organizational readiness. The purpose of this study was to explore ways to improve the measurement of organizational readiness, and in particular to refine a preliminary measure based on the Readiness = Motivation x innovation Specific Capacity x General Capacity (R = MC2) heuristic. We assessed the experiences of staff in Federally Qualified Health Centers (FQHC) implementing evidence-based interventions (EBIs) designed to increase colorectal cancer screening (CRCS) who previously completed the survey and aimed to understand their perspectives on why our data were positively skewed.

Methods: We conducted a series of qualitative interviews with FQHC employees who had previously completed the readiness survey and/or been involved with the distribution of the readiness survey. Interviews were conducted via Zoom, recorded, transcribed. Data was analyzed using an inductive approach to identify key emergent themes.

Results: Analyses revealed numerous contributors to high organizational readiness assessment scores including concerns about confidentiality, social desirability bias, knowledge of respondents about the survey content, and the survey format. Specific to the survey format, we found that survey length and response scaling likely impacted scores and the overall survey experience. Lastly, some participants shared that the tendency for high scores may reflect actual perceptions because FQHC staff are passionate, work well in teams, and typically have already worked hard to improve CRCS rates through evidence-based interventions.

Conclusion: Study findings reinforce the importance of collaborative and community-engaged survey design and the need to address the common challenges dissemination and implementation surveys may be vulnerable to. Lessons learned can be applied to other measurement work and surveys conducted across public health research. The findings will inform continued organizational readiness measure development and have implications for measurement of other factors influencing implementation.