Implementing effective and lasting organizational change is difficult and complex. In healthcare settings, many things can influence the success or failure of organizational change initiatives, from the particular needs and backgrounds of the patient population to the skills, knowledge, and beliefs of administrators, providers, and frontline staff, to the nuances of clinical policies and procedures. These factors exist in communities where policy and funding environments may range from highly challenging to very supportive. Therefore, it is helpful to approach organizational change in structured stages that break the process down into manageable pieces to avoid getting overwhelmed.
First, it is imperative to gather and evaluate information about the current state of the clinic, including patient, provider, and staff needs, policies and procedures, and the overall work environment. Second, it is crucial to prepare carefully for organizational change. Preparation includes identifying “facilitators” or elements of the clinic to support the change process (e.g., the influence of a decision leader) and “barriers” to change to be fixed or modified (e.g., lack of staff motivation or time to learn new things; bias). Another part of preparation is planning what kinds of resources and supports will be needed as changes are implemented, such as training or feedback mechanisms. Finally, implementing organizational change requires an ongoing process of reflection and reevaluation to monitor whether changes are occurring and respond to unforeseen opportunities and challenges. In the following sections, we describe this staged approach to organizational change, focusing on the conduct of organizational assessments. We also provide data collection tools and resources to get the team started.