Organizational Development Interventions and the Development of Individual Readiness for Pay-for-Performance System Change: A Participatory Action Research Case Study of a Chinese Public Hospital

This study examines how Organizational Development Interventions (ODIs) can enhance individual readiness for Pay-for-Performance (P4P) system change in Chinese public hospitals, where performance reforms often encounter resistance at the individual level. Drawing on Action Research and Participative Action Research, the study conceptualizes readiness as comprising change efficacy, change appropriateness, motivation, and personal valence. A mixed-methods design was employed, integrating pre- and post-intervention survey data from 76 physicians with qualitative insights from interviews and focus groups. The ODIs were guided by an integrated organizational diagnosis based on Galbraith's STAR Model and the SOAR framework derived from Appreciative Inquiry. Based on this diagnosis, four interventions, coaching, goal setting, performance acknowledgment, and performance appraisal, were collaboratively developed and implemented. The findings showed statistically significant improvements across all readiness dimensions (p < .001). The mean score for overall individual readiness for P4P system change increased from 2.4605 to 4.1118 on a five-point scale, while the mean motivation score improved from 2.3509 to 4.1140 following the ODIs. Qualitative findings further revealed enhanced change confidence, perceived strategic alignment, and motivational engagement among participants. This study contributes to the literature by linking ODIs with individual readiness in healthcare reform contexts and offers practical implications for designing participatory, performance-oriented change interventions in public sector organizations.