Background
Method
Study design
Participants recruitment and inclusion criteria
Ethical consideration
Data collection
Round 1
Round 2
Data analysis
Results
Characteristics of the participants
Results of the first round
Strength of consensus | ORKT dimensions & sub-dimensions | Criteria | 5-point Likert score | Percentile score | Inter-quartile range | |||
---|---|---|---|---|---|---|---|---|
A = applicability | Consensus* (Agreement in %) | |||||||
I = importance | 10th | 25th | ||||||
Strong
|
Dimension
|
1. Organizational contextual factors
|
A
|
≥75% (85,7%)
|
5
|
2
|
4
|
1
|
I
|
≥75% (85,7%)
|
5
|
2
|
4
|
1
| |||
Partial | Sub-dimensions | 1.1 Healthcare organizational characteristics | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 |
I | <60% (57,2%) | 3 | 3 | 3 | 2 | |||
Strong | 1.2 Organizational culture | A | ≥75% (78,6%) | 5 | 3 | 4 | 1 | |
I | ≥75% (85,7%) | 5 | 2 | 4 | 1 | |||
None | 1.3 General resources | A | <60% (57,2%) | 3 | 2 | 3 | 2 | |
I | <60% (57,1%) | 5 | 2 | 3 | 2 | |||
Moderate
|
Dimension
|
2. Organizational climate for change
|
A
|
≥75% (78,6%)
|
5
|
3
|
4
|
1
|
I
|
60-74% (71,5%)
|
5
|
3
|
3
|
2
| |||
None | Sub-dimensions | 2.1 Mission | A | <60% (50%) | 4 | 1 | 2 | 2 |
I | <60% (35,7%) | 3 | 1 | 2 | 2 | |||
None | 2.2 Staff cohesion | A | 60-74% (64,3%) | 4 | 2 | 3 | 1 | |
I | <60% (57,1%) | 4 | 1 | 2 | 2 | |||
None | 2.3 Autonomy | A | <60% (48,2%) | 3 | 2 | 3 | 1 | |
I | <60% (57,1%) | 4 | 1 | 2 | 2 | |||
None | 2.4 Stress | A | <60% (42,8%) | 3 | 1 | 3 | 1 | |
I | <60% (50%) | 5 | 1 | 3 | 2 | |||
Strong | 2.5 Communication | A | ≥75% (85,7%) | 5 | 2 | 4 | 1 | |
I | ≥75% (78,6%) | 5 | 2 | 4 | 1 | |||
Strong | 2.6 Openness to change | A | ≥75% (100%) | 4 | 4 | 4 | 1 | |
I | ≥75% (85,7%) | 4 | 3 | 4 | 1 | |||
None | 2.7 Political change | A | <60% (42,9%) | 3 | 1 | 3 | 1 | |
I | <60% (42,9%) | 3 | 1 | 2 | 3 | |||
Strong
|
Dimension
|
3. Management support
|
A
|
≥75% (100%)
|
5
|
4
|
4
|
1
|
I
|
≥75% (100%)
|
5
|
4
|
4
|
1
| |||
Moderate | Sub-dimensions | 3.1 Participation | A | 60-74% (71,4%) | 4 | 2 | 3 | 2 |
I | ≥75% (78,6%) | 5 | 2 | 4 | 1 | |||
Strong | 3.2 Leadership / Champion | A | ≥75% (92,9%) | 4 | 3 | 4 | 1 | |
I | ≥75% (85,7%) | 5 | 3 | 4 | 1 | |||
Strong
|
Dimension
|
4. Communication & influence
|
A
|
≥75% (85,7%)
|
4
|
2
|
4
|
1
|
I
|
≥75% (85,7%)
|
4
|
2
|
4
|
1
| |||
None | Sub-dimensions | 4.1 Discussion | A | <60% (50%) | 4 | 1 | 1 | 3 |
I | <60% (57,2%) | 4 | 1 | 1 | 3 | |||
None | 4.2 Dissemination | A | <60% (50%) | 4 | 1 | 2 | 2 | |
I | <60% (50%) | 4 | 1 | 2 | 2 | |||
Strong
|
Dimension
|
5. Motivation
|
A
|
≥75% (92,9%)
|
5
|
3
|
4
|
1
|
I
|
≥75% (100%)
|
4
|
4
|
4
|
1
| |||
None | Sub-dimensions | 5.1 Pressure for change | A | <60% (50%) | 3 | 2 | 3 | 1 |
I | <60% (57,2%) | 4 | 2 | 3 | 2 | |||
Moderate | 5.2 Change needs | A | 60-74% (64,3%) | 4 | 2 | 3 | 1 | |
I | 60-74% (64,3%) | 4 | 2 | 3 | 1 | |||
Moderate | 5.3 Training needs | A | ≥75% (78,5%) | 4 | 2 | 4 | 0 | |
I | 60-74% (64,3%) | 4 | 2 | 3 | 2 | |||
Strong
|
Dimension
|
6. Institutional support
|
A
|
≥75% (92,9%)
|
4
|
3
|
4
|
1
|
I
|
≥75% (85,7%)
|
5
|
3
|
4
|
1
| |||
Strong | Sub-dimensions | 6.1 Support climate | A | ≥75% (78,6%) | 5 | 1 | 4 | 1 |
I | ≥75% (85,7%) | 4 | 2 | 4 | 1 | |||
Moderate | 6.2 Monitoring | A | 60-74% (71,5%) | 4 | 2 | 3 | 2 | |
I | ≥75% (85,7%) | 4 | 2 | 4 | 1 | |||
Strong | 6.3 Feedback | A | ≥75% (85,8%) | 4 | 3 | 4 | 1 | |
I | ≥75% (92,9%) | 5 | 3 | 4 | 1 | |||
Strong
|
Dimension
|
7. Human resources
|
A
|
≥75% (85,8%)
|
4
|
2
|
4
|
1
|
I
|
≥75% (85,8%)
|
4
|
2
|
4
|
1
| |||
Partial | Sub-dimension | 7.1 Staff attributes | A | <60% (57,1%) | 3 | 2 | 3 | 2 |
I | 60-70% (64,3%) | 4 | 2 | 3 | 1 | |||
Strength of consensus
|
ORKT dimensions & sub-dimensions
|
Criteria
|
Consensus (Agreement in %)
|
5-point Likert score
|
Percentile score
|
Inter-quartile range
| ||
10th
|
25th
| |||||||
Moderate
|
Dimension
|
8. Organizational environment readiness
|
A
|
60-74% (71,4%)
|
4
|
2
|
3
|
2
|
I
|
60-74% (71,4%)
|
4
|
2
|
3
|
2
| |||
None | 8.1 Internal turbulences | A | <60% (50%) | 3 | 1 | 3 | 1 | |
I | <60% (35,7%) | 3 | 2 | 3 | 1 | |||
None | Sub-dimensions | 8.2 Intra/inter cooperation | A | <60% (57,2%) | 3 | 3 | 3 | 1 |
I | <60% (57,2%) | 3 | 3 | 3 | 1 | |||
None | 8.3 Organizational history of innovation | A | <60% (57,1%) | 4 | 2 | 2 | 2 | |
I | <60% (50%) | 3 | 2 | 3 | 2 | |||
Moderate | 8.4 Leader innovativeness | A | 60-74% (64,2%) | 4 | 3 | 3 | 1 | |
I | ≥75% (78,5%) | 4 | 2 | 4 | 0 | |||
Moderate
|
Dimension
|
9. Evidence
|
A
|
60-74% (71,5%)
|
4
|
2
|
3
|
2
|
I
|
60-74% (64,3%)
|
4
|
2
|
3
|
2
| |||
Moderate | 9.1 Patient experiences or preferences | A | 60-74% (64,3%) | 4 | 2 | 3 | 2 | |
I | 60-74% (71,5%) | 4 | 2 | 3 | 2 | |||
Moderate | Sub-dimensions | 9.2 Research evidence | A | 60-74% (71,5%) | 4 | 1 | 3 | 2 |
I | 60-74% (64,3%) | 4 | 1 | 3 | 2 | |||
Moderate | 9.3 Clinical evidence | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |
I | 60-74% (71,5%) | 4 | 3 | 3 | 2 | |||
Moderate
|
Dimension
|
10. End-user readiness
|
A
|
≥75% (78,6%)
|
4
|
2
|
4
|
1
|
I
|
60-74% (64,3%)
|
5
|
2
|
3
|
2
| |||
None | Sub-dimensions | 10.1 Background and skills | A | <60% (57,1%) | 3 | 2 | 3 | 1 |
I | <60% (50%) | 3 | 2 | 3 | 1 | |||
Strong | 10.2 Commitment | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |
I | ≥75% (85,7%) | 4 | 2 | 4 | 1 | |||
None | 10.3 Interpersonal responses to change | A | <60% (57,1%) | 3 | 2 | 3 | 1 | |
I | <60% (57,1%) | 4 | 2 | 3 | 1 | |||
None | 10.4 Desired and perceived involvement | A | <60% (50%) | 3 | 2 | 3 | 1 | |
I | <60% (57,2%) | 4 | 2 | 3 | 1 | |||
Strong | 10.5 Perceptions of benefits | A | ≥75% (92,9%) | 5 | 3 | 4 | 1 | |
I | ≥75% (92,9%) | 5 | 3 | 4 | 1 | |||
None | 10.6 Satisfaction | A | <60% (35,7%) | 3 | 2 | 3 | 1 | |
I | <60% (35,7%) | 3 | 1 | 3 | 2 | |||
Strength of consensus
|
ORKT dimensions & sub-dimensions
|
Criteria
|
Consensus (Agreement in %)
|
5-point Likert score
|
Percentile score
|
Inter-quartile range
| ||
10th
|
25th
| |||||||
Partial
|
Dimension
|
11. External influence
|
A
|
60-74% (71,4%)
|
5
|
4
|
4
|
1
|
I
|
<60% (57,2%)
|
4
|
3
|
3
|
1
| |||
None | Sub-dimensions | 11.1 External system | A | <60% (28,6%) | 3 | 2 | 2 | 2 |
I | <60% (28,5%) | 3 | 2 | 2 | 2 | |||
None | 11.2 Features of the change setting | A | <60% (57,1%) | 4 | 2 | 3 | 1 | |
I | <60% (57,2%) | 4 | 2 | 3 | 2 | |||
Partial
|
Dimension
|
12. Operational readiness
|
A
|
60-74% (64,3%)
|
4
|
3
|
3
|
1
|
I
|
<60% (57,2%)
|
3
|
2
|
3
|
2
| |||
None | Sub-dimensions | 12.1 Durability | A | <60% (42,9%) | 4 | 1 | 2 | 2 |
I | <60% (42,9%) | 4 | 1 | 2 | 2 | |||
None | 12.2 Consistency | A | <60% (28,6%) | 3 | 1 | 3 | 1 | |
I | <60% (35,7%) | 3 | 1 | 2 | 2 | |||
None | 12.3 Reliability | A | <60% (35,7%) | 3 | 1 | 3 | 1 | |
I | <60% (28,5%) | 3 | 1 | 3 | 1 | |||
Moderate | 12.4 Accessibility | A | 60-74% (64,3%) | 4 | 1 | 3 | 2 | |
I | 60-74% (64,3%) | 4 | 1 | 3 | 2 | |||
None | 12.5 Processing speed | A | <60% (42,8%) | 3 | 1 | 2 | 1 | |
I | <60% (35,7%) | 3 | 1 | 2 | 1 | |||
Moderate | 12.6 Ease to use | A | 60-74% (71,4%) | 4 | 2 | 3 | 1 | |
I | 60-74% (71,4%) | 4 | 3 | 3 | 1 | |||
None
|
Dimension
|
13. Organizational change content
|
A
|
<60% (57,1%)
|
5
|
2
|
3
|
2
|
I
|
<60% (57,2%)
|
5
|
2
|
3
|
2
| |||
Partial | Sub-dimensions | 13.1 Values and goals | A | 60-74% (64,3%) | 4 | 3 | 3 | 1 |
I | <60% (57,2%) | 3 | 2 | 3 | 2 | |||
Strong | 13.2 Attributes of change | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |
I | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |||
None
|
Dimension
|
14. Perceived options for change
|
A
|
<60% (57,2%)
|
5
|
2
|
3
|
2
|
I
|
<60% (57,2%)
|
4
|
2
|
3
|
2
| |||
None | Sub-dimensions | 14.1 Understand history of change | A | <60% (50%) | 2 | 1 | 2 | 1 |
I | <60% (35,7%) | 3 | 1 | 2 | 1 | |||
Partial | 14.2 Approach to change initiatives | A | <60% (57,1%) | 4 | 2 | 3 | 1 | |
I | 60-74% (64,3%) | 3 | 3 | 3 | 2 | |||
None | 14.3 Evaluation of opportunities for change | A | <60% (50%) | 3 | 2 | 3 | 1 | |
I | <60% (50%) | 3 | 2 | 3 | 1 | |||
Strength of consensus
|
ORKT dimensions & sub-dimensions
|
Criteria
|
Consensus (Agreement in %)
|
5-point Likert score
|
Percentile score
|
Inter-quartile range
| ||
10th
|
25th
| |||||||
None
|
Dimension
|
15. Knowledge readiness
|
A
|
<60% (35,7%)
|
3
|
2
|
3
|
2
|
I
|
<60% (42,9%)
|
3
|
2
|
3
|
2
| |||
None | Sub-dimensions | 15.1 General knowledge | A | <60% (35,7%) | 3 | 1 | 2 | 2 |
I | <60% (35,7%) | 3 | 1 | 2 | 2 | |||
Moderate | 15.2 Specific knowledge | A | 60-74% (71,5%) | 4 | 3 | 3 | 2 | |
I | 60-74% (71,5%) | 4 | 3 | 3 | 2 | |||
None
|
Dimension
|
16. Process readiness
|
A
|
<60% (50%)
|
3
|
2
|
3
|
1
|
I
|
<60% (42,8%)
|
3
|
2
|
3
|
1
| |||
Moderate | Sub-dimensions | 16.1 Evaluation process | A | 60-74% (71,4%) | 4 | 3 | 3 | 2 |
I | 60-74% (71,4%) | 4 | 3 | 3 | 2 | |||
None | 16.2 Quality process | A | <60% (57,1%) | 4 | 2 | 3 | 1 | |
I | <60% (50%) | 4 | 2 | 3 | 1 | |||
None | 16.3 Financial management | A | <60% (42,9%) | 3 | 2 | 3 | 2 | |
I | <60% (42,8%) | 3 | 2 | 3 | 1 | |||
Strong | 16.4 Strategic planning process | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |
I | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |||
Strong | 16.5 Decision-making process | A | ≥75% (78,6%) | 4 | 3 | 4 | 1 | |
I | ≥75% (85,7%) | 4 | 2 | 4 | 0 | |||
None
|
Dimension
|
17. Innovation customization process
|
A
|
<60% (42,9%)
|
2
|
2
|
2
|
2
|
I
|
<60% (42,9%)
|
2
|
2
|
2
|
2
| |||
Partial | Sub-dimensions | 17.1 Routine use | A | <60% (57,1%) | 4 | 1 | 2 | 2 |
I | 60-74% (64,3%) | 4 | 1 | 2 | 3 | |||
Partial | 17.2 Adoption consequences | A | 60-74% (71,4%) | 4 | 3 | 3 | 1 | |
I | <60% (51,5%) | 4 | 3 | 3 | 1 | |||
None | 17.3 Innovation diffusion | A | <60% (21,4%) | 5 | 1 | 2 | 3 | |
I | <60% (21,4%) | 5 | 1 | 1 | 4 | |||
Moderate | 17.4 Innovation implementation | A | ≥75% (85,7%) | 4 | 3 | 4 | 0 | |
I | 60-74% (71,5%) | 4 | 3 | 3 | 2 | |||
Moderate | 17.5 Innovation adoption | A | 60-74% (64,3%) | 5 | 1 | 3 | 2 | |
I | 60-74% (64,3%) | 5 | 1 | 3 | 2 |
Results of the second round
Strength of consensus | ORKT sub-dimensions | Criteria A = applicability | Consensus* (Agreement in %) | 5-point Likert score | Percentile score | Inter-quartile range | |
---|---|---|---|---|---|---|---|
10th | 25th | ||||||
Staff cohesion | A | ≥75% (80%) | 4 | 3 | 4 | 1 | |
Staff work-related stress | A | ≥75% (90%) | 4 | 3 | 4 | 1 | |
Strong
| Communication about change | A | ≥75% (90%) | 5 | 3 | 4 | 1 |
Manager’s openness to change | A | ≥75% (80%) | 4 | 3 | 4 | 1 | |
Appropriate human resources to support change | A | ≥75% (100%) | 5 | 4 | 4 | 1 | |
Appropriate material resources to support change | A | ≥75% (80%) | 5 | 3 | 4 | 1 | |
Attributes of change | A | ≥75% (100%) | 4 | 4 | 4 | 1 | |
Perceived complexity of change | A | ≥75% (100%) | 4 | 4 | 4 | 1 | |
Patient experiences and preferences | A | ≥75% (80%) | 4 | 3 | 4 | 1 | |
Clinical evidence supporting change | A | ≥75% (80%) | 4 | 2 | 4 | 1 | |
Staff participation | A | ≥75% (90%) | 4 | 3 | 4 | 1 | |
Leadership/Champion | A | ≥75% (100%) | 5 | 4 | 5 | 0 | |
Strategic planning process | A | ≥75% (90%) | 4 | 3 | 4 | 0 | |
Adequate level of involvement | A | ≥75% (80%) | 4 | 3 | 4 | 1 | |
Evaluation process | A | ≥75% (100%) | 4 | 4 | 4 | 1 | |
Feedback | A | ≥75% (100%) | 5 | 4 | 4 | 1 | |
Pressure for change | A | ≥75% 100%) | 4 | 3 | 4 | 0 | |
Change needs | A | ≥75% (90%) | 4 | 3 | 4 | 0 | |
Adequate knowledge and skills | A | ≥75% (80%) | 4 | 2 | 4 | 0 | |
Commitment | A | ≥75% (90%) | 5 | 2 | 4 | 1 | |
Perception of benefits | A | ≥75% (100%) | 4 | 4 | 4 | 1 | |
Moderate
| Change alignment with organization’s mission | A | 60-74% (70%) | 3 | 2 | 3 | 0 |
Organizational culture | A | 60-74% (70%) | 5 | 3 | 3 | 2 | |
Research evidence supporting change | A | 60-74% (60%) | 4 | 2 | 3 | 1 | |
Leader innovativeness | A | 60-74% (60%) | 3 | 3 | 3 | 2 | |
Decision-making process | A | 60-74% (70%) | 4 | 3 | 3 | 1 | |
Support climate | A | 60-74% (70%) | 4 | 3 | 3 | 1 | |
Monitoring | A | 60-74% (60%) | 4 | 2 | 3 | 1 | |
Training and education needs | A | 60-74% (70%) | 4 | 2 | 3 | 1 | |
None
| Organizational history of innovation | A | >60% (40%) | 3 | 2 | 2 | 2 |