The online version of this article (https://doi.org/10.1186/s12903-017-0448-4) contains supplementary material, which is available to authorized users.
Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment.
A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy.
Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company’s mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0.45 and 0.8-unit increases in change commitment and change efficacy.
The survey identified positive readiness for change and highlighted weaknesses that are important cautions for this organization and others initiating change. Future studies will examine how organizational readiness to change, workforce characteristics and work environment influenced successful implementation within this organization.
Wall T, Guay A. Very large dental practices seeing significant growth in market share. Health Policy Institute Research Brief. Chicago: American Dental Association; 2015. Available from: http://www.ada.org/sections/professionalResources/pdfs/HPIBrief_0815_2.pdf.
Bailit H, Plunkett M, Schwarz E. The Oregon dental market: a case study. J Am Coll Dent. 2016;83(2):14–23.
Ku L, Sharac J, Bruen B, Thomas M, Norris L. Increased use of dental services by children covered by Medicaid: 2000–2010. Medicare Medicaid Res Rev. 2013;3(3):E1–E12. CrossRef
Becan JE, Knight DK, Flynn PM. Innovation adoption as facilitated by a change-oriented workplace. J Subst Abus Treat. 2012;42(2):179–90. CrossRef
Bouckenooghe D, Devos G, van den Broeck H. Organizational change questionnaire-climate of change, processes, and readiness: development of a new instrument. Aust J Psychol. 2009;143(6):559–99. CrossRef
Claiborne N, Auerbach C, Lawrence C, Schudrich WZ. Organizational change: the role of climate and job satisfaction in child welfare workers’ perception of readiness for change. Child Youth Serv Rev. 2013;35(12):2013–2019. CrossRef
Jones RA, Jimmieson NL, Griffiths A. The impact of organizational culture and reshaping capabilities on change implementation success: the mediating role of readiness for change. J Manag Stud. 2005;42(2):361–86. CrossRef
Holt DT, Armenakis AA, Feild HS, Harris SG. Readiness for organizational change the systematic development of a scale. J Appl Behav Sci. 2007;43(2):232–55. CrossRef
Lehman WE, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abus Treat. 2002;22(4):197–209. CrossRef
Shea CM, Reiter KL, Weaver MA, McIntyre M, Mose J, Thornhill J, Malone R, Weiner BJ. Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system. BMC Med Inform Decis Mak. 2014;14:119. CrossRefPubMedPubMedCentral
Linzer M, Baier Manwell L, Mundt M, Williams E, Maguire A, McMurray J, Plane MB. Organizational climate, stress, and error in primary care: the MEMO study. Advances in patient safety: from research to implementation (volume 1: research findings). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005.
DeMeester RH, Xu LJ, Nocon RS, Cook SC, Ducas AM, Chin MH. Solving disparities through payment and delivery system reform: a program to achieve health equity. Health Aff (Millwood). 2017;36(6):1133–9. CrossRef
Cunha-Cruz J, Milgrom P, Shirtcliff RM, Bailit HL, Huebner CE, Conrad D, Ludwig S, Mitchell M, Dysert J, Allen G, et al. Population-centered risk- and evidence-based dental Interprofessional care team (PREDICT): study protocol for a randomized controlled trial. Trials. 2015;16:278. CrossRefPubMedPubMedCentral
Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, Schwartz MD, Scheckler WE, Van Kirk J, Rhodes E, et al. Refining the measurement of physician job satisfaction: results from the physician worklife survey. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37(11):1140–54. CrossRefPubMed
Rohland BM, Kruse GR, Rohrer JE. Validation of a single-item measure of burnout against the Maslach burnout inventory among physicians. Stress Health. 2004;20(2):75–9. CrossRef
- Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States
Colleen E. Huebner
R. Mike Shirtcliff
- BioMed Central
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