Implementing Specialized Vestibular Physiotherapy in An Emergency Department: A Process Evaluation

Background: Dizziness and vertigo-like symptoms, often caused by common peripheral vestibular disorders such as Benign Paroxysmal Positional Vertigo (BPPV), may have a significant detrimental impact on function and quality of life. The impact of these symptoms often result in Emergency Department (ED) presentations. Evidence based clinical practice guidelines strongly recommend the use of physical assessment and treatment maneuvers for the assessment, diagnosis and treatment of these symptoms. The aim of this study was to evaluate the process of implementing specialized vestibular physiotherapy in an emergency department, from the clinician perspective.Methods: This implementation study utilized a retrospective mixed methods process evaluation to understand how specialized vestibular physiotherapy operated in an Australian emergency department. The PARiHS Framework was embedded within the methodology and analytical approach of the study, to ensure a comprehensive approach which was closely aligned to implementation science. Nine clinicians retrospectively completed the Organizational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Seven clinicians also participate in a focus group or interview.Results: A range of barriers and facilitators to the implementation process were identified by participants, some of which spanned multiple domains of the PARiHS framework. Relationships with service leaders, champions and medical staff were found to be a key facilitator to implementation, along with a generally held perception that specialized vestibular physiotherapy was acceptable and feasible. The main barrier identified was a lack of capacity to deliver and support this innovation, both within the physiotherapy workforce and the broader multidisciplinary team.Conclusions: This study demonstrates the process of implementation of a specialized vestibular physiotherapy team in an ED setting was generally well received by clinicians, but also involved some challenges and barriers. Services looking to implement specialized vestibular physiotherapy in the ED may refer to the recommendations arising from the findings of this study to guide their approach to innovation.

Assessment of organizational readiness for participatory occupational safety, health and well-being programs

BACKGROUND: Organizational readiness for change measures were reviewed to develop an assessment tool for guiding implementation of an occupational safety and health program based on Total Worker Health (TWH) principles. Considerable conceptual ambiguity in the theoretical and empirical peer-reviewed literature was revealed. OBJECTIVE: Develop and validate an assessment tool that organizations can use to prepare for implementation of a participatory TWH program. METHODS: Inclusion criteria identified 29 relevant publications. Analysis revealed eight key organizational characteristics and predictors of successful organizational change. A conceptual framework was created that subject matter experts used to generate prospective survey items. Items were revised after pretesting with 10 cognitive interviews with upper-level management and pilot-tested in five healthcare organizations. Reliability of the domain subscales were tested based on Cronbach’s α. RESULTS: The Organizational Readiness Tool (ORT) showed adequate psychometric properties and specificity in these eight domains: 1) Current safety/health/well-being programs 2) Current organizational approaches to safety/health/well-being; 3) Resources available for safety/health/well-being; 4) Resources and readiness for change initiatives to improve safety/health/well-being; 5) Resources and readiness for use of teams in programmatic initiatives; 6) Teamwork; 7) Resources and readiness for employee participation; and 8) Management communication about safety/health/well-being Acceptable ranges of internal consistency statistics for the domain subscales were observed. CONCLUSIONS: Development of a conceptual framework for organizational readiness for change guided item generation for an assessment tool. Items were then refined based on cognitive interviews with specified end users. Initial internal consistency was demonstrated following administration at multiple organizations prior to implementation of a participatory Total Worker Health ® program.

Impact of Paternalistic Leadership on Organizational Readiness for Change: Mediating Role of Employee Engagement and Moderating Role of Islamic Work Ethics

Purpose: This study aims to investigate the impact of paternalistic leadership on organizational readiness for change: mediation of employee engagement and moderation of Islamic work ethics (IWE). Methodology: The sample size for this research is 203. The data were collected from faculty of private and public sector educational institutes that were in process of change. SPSS has been utilized for data analysis. Findings: Using Leader-Member Exchange (LMX) as a theoretical lens, the results indicate paternalistic leadership significantly positively impacts organizational readiness for change; employee engagement acts as a mediating agent between paternalistic leadership and organizational readiness for change; IWE moderates between the relationship of paternalistic leadership and employee engagement. Significance: The mediation of employee engagement and moderation of IWE between paternalistic leadership and organizational readiness for change is still under research so this makes our research a unique contribution. Limitations: This research shall add to the Islamic ethical principles of employees alongside output which will advantage the organization as well as employees. Implications: This research has managerial implications for change agents, organizational development (OD) consultants; policymakers of educational institutions, and professionals regarding change strategies, benefits, and the Islamic business environment.

An Implementation Blueprint for How to Start Interprofessional Behavioral Health Integration in A Healthcare System: Balancing Patient Needs, Organizational Readiness for Change, Institutional Priorities, and Training Needs.

Background Poor health behaviors are epidemic and lead to chronic disease. Further, there are already hundreds of behavioral health interventions that have shown efficacy for preventing chronic diseases long term. These services are not yet widely available to patients, especially those at high risk for developing chronic diseases: Health disparities exist by race, ethnicity, income, gender, sexual orientation, mental health status, and area. Additionally, mental health issues are also highly prevalent and largely untreated and can be a barrier to preventative care. In recent years, there has been in a movement towards integrating mental health professionals who do behavioral health medicine into primary care and medical clinics to increase access. While this behavioral health integration has been shown to lead to better patient outcomes and decreased costs, and while this practice is growing in popularity, still very few healthcare systems are utilizing this model. While there are implementation science studies for integrating into a single clinic, no dissemination and implementation study to our knowledge has developed a strategy for integration across a large healthcare system. Methods We used four surveys of opinion leaders (N = 12), clinic providers (N = 15), hospital administrators (N = 2), and D&I scientists (N = 27), to asked about barriers and facilitators to integration, as well as: patient need, organizational readiness for change, and student training needs for a sustainable model for integration. Results We learned about key barriers and facilitators to integration within this healthcare system. Importantly, we extrapolated or coded numeric values for each clinic for patient need, organizational readiness for change, and student training needs, creating a priority score for each clinic. When we begin integration, we will start with integrating the most-ready clinic with the most in-need patients and the most perceived student-training need, and move down there. With this process, we created a novel implementation science system for identifying and prioritizing clinics for integration, barriers and facilitators in each clinic, and draw from published work and established models in the field (ORIC, Dynamic Sustainability, RE-AIM). Conclusions This study provides a blueprint for other healthcare systems to create a plan for sustainable integration of psychological services into medical settings for the benefit of healthcare systems, patients, and public health.

WHY IS THE INFLUENCE OF SERVANT LEADERSHIP ON ORGANIZATIONAL READINESS FOR CHANGE INSIGNIFICANT? THE MEDIATING ROLE OF WORKPLACE SPIRITUALITY

The COVID-19 pandemic has exponentially accelerated the rate of change. Organizational readiness for change has become the mandatory requirement for most organizations to survive in this highly disrupted era. The purpose of this research is to investigate the influence of servant leadership and the mediating role of workplace spirituality on organizational readiness for change. Offices within a private university in Indonesia were used as the population for this research. 80 respondents from 40 offices participated in this research by filling online questionnaires. The data were analyzed using Partial Least Square–Structural Equation Modelling software. The results show that servant leadership does not influence organizational readiness for change directly butis fully mediated through workplace spirituality. This paper contributes to the organizational change theory by providing insight into what aspect of servant leadership may be lacking for an extreme organizational change process. It is the first study that validates the role of workplace spirituality as the mediator of the relationship between servant leadership and organizational readiness for change.

Are Danish vocational schools ready to implement “smoke-free school hours”? A qualitative study informed by the theory of organizational readiness for change

Background The smoking prevalence is high among students enrolled in vocational education and training, which is considered a lower level of education. The school tobacco policy regarding smoke-free school hours stipulates that students and staff are not allowed to smoke during school hours—inside or outside school premises—and it might be an effective intervention for reducing smoking in vocational schools. For school tobacco policies to be effective, they must be appropriately implemented. A primary predictor for successful implementation is organizational readiness for change. This study seeks to identify and understand the barriers to and facilitators for developing organizational readiness to implement smoke-free school hours in Danish vocational schools. Methods Semi-structured interviews and focus groups were carried out with managers and teachers (n = 22 participants) from six vocational schools. The interview guides were informed by “A theory of organizational readiness for change” developed by Weiner, which was also used as a framework to analyze the data. Results We identified 13 facilitators and barriers. Nine factors acted as facilitators, including the following: believing that health promotion is a school role and duty; believing that society and workplaces are becoming more smoke-free, and believing that smoke-free school hours is a beneficial strategy to achieve fewer educational interruptions. Additional facilitators include establishing clear rules for sanctioning and enforcement, developing a joint understanding about smoke-free school hours, developing skills to deal with student responses to smoke-free school hours, establishing social alternatives to smoking, offering smoking cessation help, and mandating smoke-free school hours by law. Four organizational norms, practices, or discourses acted as barriers: believing that smoke-free school hours violate personal freedom, believing that students have more important problems than smoking, believing that it is difficult to administer the level of enforcement, and believing that the enforcement of smoke-free school hours negatively influences student-teacher relations. Discussion Our results suggest that developing organizational readiness before adopting a comprehensive tobacco policy such as smoke-free school hours is important for successful implementation. Further research should investigate how to strengthen the facilitators for and counter the barriers to developing readiness for implementing smoke-free school hours.

The Role of Transformational Entrepreneurship, Readiness to Change and Counterproductive Work Behavior in Enhancing Employee Performance

Background and Purpose: The company sustainability balancing economic with social impact to coexist whilst the transformation entrepreneurship create the coexist. The purpose of this research is to better understand the consequences of transformational entrepreneurship, in terms of increasing organizational readiness for change, minimizing counterproductive work behavior and enhancing employee performance. In addition, this paper aims to comprehend the extent to which organizational readiness for change and counterproductive work behavior affect employee performance. Methodology: The data were collected via a survey of 257 branches of a state-owned bank. The structural equation model (SEM) was used to test the proposed model. Findings: Transformational entrepreneurship positively and significantly affect organizational readiness for change and employee performance, and negatively and significantly affect counterproductive work behavior. Moreover, the result demonstrated a significantly positive effect of organizational readiness for change on employee performance, and demonstrated a significantly negative effect of counterproductive work behavior on employee performance. Conclusion: Point of this study is the effectiveness of transformational entrepreneurship in directly affecting employees’ performance. However, the effect transformational entrepreneurship has on readiness for change and counterproductive work behavior adds its impact on employees’ performance and based on the direct effect, readiness for comes up much more impactful than the other two. It implies how volatile and dynamics the work (internal and external) situations that having employees ready for change can help them cope with such volatility and dynamics to reach better performance.