Journal of General Internal Medicine

, Volume 25, Supplement 1, pp 50–55 | Cite as

Are You Ready? How Health Professionals Can Comprehensively Conceptualize Readiness for Change

  • Daniel T. HoltEmail author
  • Christian D. Helfrich
  • Carmen G. Hall
  • Bryan J. Weiner


One important factor influencing the successful implementation of system-wide change is initial readiness. Readiness is defined as the degree to which those involved are individually and collectively primed, motivated, and technically capable of executing the change. We present a conceptual framework that highlights three broad areas to be considered if health-care professionals are to comprehensively evaluate readiness that includes psychological factors (i.e., characteristics of those being asked to change), structural factors (i.e., circumstances under which the change is occurring) as well as the level of analysis (i.e., individual and organizational levels). We also describe more specific dimensions within each of these broad categories that have both empirical and theoretical support, presenting several valid and reliable survey instruments that measure key dimensions of readiness quantitatively.


organizational change change readiness measuring readiness for change implementation 



This material is based upon a workshop led during the 2008 National Meeting of the Quality Enhancement Research Initiative (QUERI) of the Health Services R&D Service, Department of Veterans Affairs.

The views expressed here are those of the authors, who are responsible for its contents, and do not necessarily represent the views of the US Departments of Defense or Veterans Affairs.

Conflict of Interest Statement

The authors have no conflicts that directly or indirectly, purposefully or inadvertently affect the conduct, outcome, or reporting of any information included in this manuscript.


  1. 1.
    Hughes JR. Motivating and helping smokers to stop smoking. J Gen Intern Med. 2003;18:1053–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Hung DY, Shelley DR. Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care. Health Service Research. 2008;44(1):103–27.CrossRefGoogle Scholar
  3. 3.
    Fiore MC, Bailey WC, Cohen SJ, et al. Smoking cessation. Clinical Practice Guideline No. 18. Rockville, MD, US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 96-0692. April 1996.Google Scholar
  4. 4.
    Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service; 2008.Google Scholar
  5. 5.
    Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence Clinical Practice Guideline. Rockville, MD: Public Health Service; 2000.Google Scholar
  6. 6.
    Keller PA, Fiore MC, Curry SJ, Orleans CT. Systems changes to improve health and health care; lessons from addressing tobacco in managed care. Nicotine Tob Res. 2005;7:S5–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Revell CC, Schroeder SA. Simplicity matters: using system-level changes to encourage clinician intervention in helping tobacco users to quit. Nicotine Tob Res.;7:S67–69.Google Scholar
  8. 8.
    Hamlett-Berry K, Davison J, Kivlahan DR, Matthews MH, Hendrickson JE, Almenoff PL. Evidence-based national initiatives to address tobacco use as a public health priority in the veterans health administration. Military Medicine.;174:29–34.Google Scholar
  9. 9.
    Herr K, Titler MG, Schilling ML, Marsh JL, Xie X, Ardery G, Clarke WR, Everett LQ. Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers. Clin J Pain. 2004;20(5):331–40.CrossRefPubMedGoogle Scholar
  10. 10.
    McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New Engl J Med. 2003;348(26):2635–45.CrossRefPubMedGoogle Scholar
  11. 11.
    Nembhard IM, Alexander JA, Hoff TJ, Ramanujam R. Why does quality of health care continue to lag? Insights from management research. Academy of Management Perspectives. 2009;23:24–42.Google Scholar
  12. 12.
    Kotter JP. Leading change: Why transformation efforts fail. Harvard Bus Rev. 1995;73:59–67.Google Scholar
  13. 13.
    Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982;19:276–88.CrossRefGoogle Scholar
  14. 14.
    Van de Ven AH, Poole MS. Explaining development and change in organizations. Acad Manage Rev. 1995;20(3):510–41.CrossRefGoogle Scholar
  15. 15.
    Holt DT, Armenakis AA, Harris SG, Feild HS. Toward a comprehensive definition of readiness for change: A review of research and instrumentation. In: Pasmore WA, Woodman RW, eds. Research in Organizational Change and Development. Oxford, UK: Elsevier; 2007;16:289–336.Google Scholar
  16. 16.
    Weiner BJ, Amick H, Lee SYD. Conceptualization and measurement of organizational readiness for change: A review of the literature in health services research and other fields. Med Care Res Rev. 2008;65:379–436.CrossRefPubMedGoogle Scholar
  17. 17.
    Armenakis AA, Harris SG, Mossholder KW. Creating readiness for organizational change. Hum Relat. 1993;46(6):681–703.CrossRefGoogle Scholar
  18. 18.
    Beer M, Walton AE. Organization change and development. Annu Rev Psychol. 1987;38:339–67.CrossRefGoogle Scholar
  19. 19.
    Wanberg CR, Banas JT. Predictors and outcomes of openness to changes in a reorganizing workplace. J Appl Psychol. 2000;85:132–42.CrossRefPubMedGoogle Scholar
  20. 20.
    McCluskey A, Cusick A. Strategies for introducing evidence-based practice and changing clinician behaviour: A manager’s toolbox. Aust Occup Ther J. 2002;49:63–70.CrossRefGoogle Scholar
  21. 21.
    Moulding N, Silagy C, Weller D. A framework for effective management of change in clinical practice: Dissemination and implementation of clinical practice guidelines. Qual Health Care. 1999;8(3):177–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Eby LT, Adams DM, Russell JEA, Gaby SH. Perceptions of organizational readiness for change: Factors related to employees’ reactions to the implementation of team-based selling. Hum Relat. 2000;53:419–42.CrossRefGoogle Scholar
  23. 23.
    Armenakis AA, Bedeian AG. Organizational change: A review of theory and research in the 1990s. J Manage. 1999;25:293–315.CrossRefGoogle Scholar
  24. 24.
    Burke WW, Coruzzi CA, Church AH, eds. The organizational survey as an intervention for change. San Francisco: Jossey-Bass Publishers; 1996.Google Scholar
  25. 25.
    Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, Zhu SH. The impact of financial incentives and patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. 2003;36:291–99.Google Scholar
  26. 26.
    Armenakis AA, Harris SG. Reflections: Our journey in organizational change research. J Chang Manag. 2009;9:127–42.CrossRefGoogle Scholar
  27. 27.
    Holt DT, Armenakis AA, Harris SG, Feild HS. Readiness for organizational change: The systematic development of a scale. J Appl Behav Sci. 2007;43(2):232–55.CrossRefGoogle Scholar
  28. 28.
    Bandura A. Self-efficacy mechanism in human agency. Am Psychol. 1982;37:122–47.CrossRefGoogle Scholar
  29. 29.
    Bernerth J. Expanding our understanding of the change message. Human Resource Development Review. 2004;3:36–53.CrossRefGoogle Scholar
  30. 30.
    Cole MC, Harris SG, Bernerth JB. Exploring the implications of vision, appropriateness, and execution of organizational change. Leadersh Organ Dev J. 2006;27:352–67.CrossRefGoogle Scholar
  31. 31.
    Armenakis AA, Bernerth JB, Pitts Walker HJ. Organizational change recepients’ beliefs scale: Development of an assessment instrument. J Appl Behav Sci. 2007;43:481–505.CrossRefGoogle Scholar
  32. 32.
    Weiner BJ, Lee SYD. Measuring readiness for organizational change. Unpublished study. 2008.Google Scholar
  33. 33.
    Herscovitch L, Meyer JP. Commitment to organizational change: Extension of a three component model. J Appl Psychol. 2002;87:474–87.CrossRefPubMedGoogle Scholar
  34. 34.
    Pond S, Armenakis AA, Green S. The importance of employee expectations in organizational diagnosis. J Appl Behav Sci. 1984;20:167–180.CrossRefPubMedGoogle Scholar
  35. 35.
    Helfrich C, Li Y-F, Sharp ND, Sales A. Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARiHS) framework. Implementation Science. 2009;4:38.CrossRefPubMedGoogle Scholar
  36. 36.
    Gustafson DH, Steudel HJ. What Everyone in Health Care Needs to Know about Managing Organizational Change. A Team Guide to the Organizational Change Manager (OCM). Madison, WI: Madison Healthcare Improvement, LLC; 1998.Google Scholar
  37. 37.
    Gustafson DH, Sainfort F, Eichler M, Adams L, Bisognano M, Steudel H. Developing and testing a model to predict outcomes of organizational change. Health Serv Res. 2003;38:751–76.CrossRefPubMedGoogle Scholar
  38. 38.
    Molfenter T, Gustafson D, Kilo C, Bhattacharya A, Olsson J. Prospective evaluation of a Bayesian Model to predict organizational change. Health Care Manage Rev. 2005;30:270–79.PubMedGoogle Scholar
  39. 39.
    Ford JH, Quanbeck A, Gustafson DH, Eichler M, Bhattacharya A, Steudel HJ. Psychometric properties of the Organizational Change Manager (OCM), an instrument for predicting and explaining the success of organizational change efforts. Unpublished manuscript; 2008.Google Scholar
  40. 40.
    Hagedorn H, Hogan M, Smith JL, Bowman C, Curran GM, Espadas D, Kimmel B, Kochevar L, Legro MW, Sales AE. Lessons learned about implementing research evidence into clinical practice: Experiences from VA QUERI. J Gen Internal Medicine. 2006;21(S2):S21–24.Google Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Daniel T. Holt
    • 1
    Email author
  • Christian D. Helfrich
    • 2
  • Carmen G. Hall
    • 3
  • Bryan J. Weiner
    • 4
  1. 1.Department of Systems and Engineering ManagementAir Force Institute of Technology, AFIT/ENVWright PattersonUSA
  2. 2.Ischemic Heart Disease QUERIVA Puget Sound Health Care SystemSeattleUSA
  3. 3.Polytrauma and Blast-Related Injuries-QUERIVA Minneapolis Health Care SystemMinneapolisUSA
  4. 4.University of North CarolinaChapel HillUSA

Personalised recommendations