Assessing healthcare organizational readiness to implement risk-stratified breast cancer screening in Canada: A cross-sectional questionnaire study

Abstract Background: Organizational readiness for change is a critical precursor of successful implementation of evidence-based practices. This study assessed the readiness of Canadian healthcare organizations to implement risk-stratified breast cancer screening (RSBS). Methods: We conducted a cross-sectional questionnaire study with healthcare professionals involved in delivering/administrating breast screening programs, and policymakers in Canada. Organizational readiness was assessed using the Organizational Readiness for Implementing Change (ORIC) scale (comprising change commitment (CC) and change efficacy (CE)) subscales. Change valence (CV), a determinant of organizational readiness was also assessed using Shea et al’s change valence scale. All items used 5-point Likert scales (1=Disagree to 5=Agree). Results: Of the 338 participants who attempted the questionnaire, 237 fully completed it. Median (IQR) scores, where higher scores indicate greater agreement with the statements suggesting greater perceived organizational readiness, were: ORIC 3.50 (3.00–4.25), CC 3.50 (3.00–4.50), CE 3.40 (3.00–4.20), CV 4.00 (3.50–4.60). Readiness ranged from “uncertain” to “somewhat ready” with no significant differences across interest-holder levels. A gap between value and capacity was evident: 87% agreed RSBS aligned with their organizational values, but only 42–50% felt confident in their organizations management of politics or supporting staff. Agreement that RSBS “makes sense” was associated with higher perceived readiness and change valence (all p≤0.002). Conclusions: Healthcare professionals perceived their organizations as somewhat valuing RSBS but less certain about commitment and capacity to deliver it. Strengthening readiness would require visible leadership, positioning of RSBS as an organizational priority, and enhanced capacity to manage politics, support staff, sustain momentum, and monitor progress. These findings highlight the opportunity and need to proactively build readiness to enhance implementation and strengthen the empirical evidence on how readiness influences RSBS adoption. Keywords: Implementation science; risk-stratified screening; breast cancer; organizational readiness