“On Your Mark”: a pilot implementation study of a readiness for change module in the SHIFT intervention

Readiness for change (R4C) is an important antecedent of care practice change and is linked to a range of implementation and effectiveness outcomes. We describe the creation, piloting, and evaluation of R4C activities intended to help nursing home (NH) teams implement a quality improvement intervention. We developed and operationalized an R4C module with activities conducted with NH leaders during intervention recruitment. An implementation pilot was conducted in three NHs and evaluated using a mixed-methods process evaluation guided by Proctor’s (2011) implementation outcomes framework. R4C activities were feasible, acceptable, and delivered with fidelity. The approach promoted readiness among senior leaders, but not among front-line teams. Results also showed (1) R4C activities are closely tied to other variables (e.g. NH leadership facilitation) that influence implementation, and (2) core R4C components (i.e. change efficacy) can emerge during an intervention, pending teams’ perceived success. We suggest conducting R4C activities with all of those involved across an organization who have a role to play in change implementation. Findings also reveal challenges associated with isolating the effects of “pre-intervention” R4C activities on intervention implementation and success. Pilot results will inform a larger-scale quality improvement study.