Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship

• Lower complexity healthcare facilities have lower readiness to change. • Lower complexity healthcare facilities report more antibiotic stewardship challenges. • Resources for stewardship scored lower than other areas of organizational readiness. Prior to implementing a multisite antibiotic stewardship intervention for asymptomatic bacteriuria, we performed the organizational readiness to change assessment (ORCA) and an antibiotic stewardship challenges survey. We hypothesized that facility complexity would be related to organizational readiness to change and perceived challenges to antibiotic stewardship. ORCA and antibiotic stewardship challenges surveys were conducted at 40 Veterans Health Administration (VHA) medical centers (inpatient acute and long-term care). VHA healthcare facility complexity ranges from level 1 (high) to level 3 (low) based on volume and acuity of care. Mean Likert scores were calculated for each ORCA subscale. We compared survey results for complexity level 3 sites versus combined complexity level 1 and 2 sites. 30 VHA sites completed at least 3 ORCA surveys and were included for analysis ( n = 202 surveys). Overall ORCA scores were significantly lower at level 3, least complex, facilities compared to levels 1 and 2 ( P = 0.046). Level 3 facilities reported significantly more antibiotic stewardship challenges (median = 10, interquartile range [IQR] = 4.5–11.2) versus levels 1 and 2 (median = 3, IQR 2.0–5.7, P = 0.004). Level 3 facilities also reported significantly lower provider/prescriber buy-in ( P = 0.005), microbiology resources ( P = 0.009), and stewardship or infectious diseases subject matter expertise ( P = 0.003). In a national sample, low complexity sites reported a lower readiness to change and perceived a higher number of antibiotic stewardship challenges. Less complex healthcare facilities may have fewer resources overall, decreasing their readiness to implement antibiotic stewardship interventions.