In this article, I sought to conceptually define organizational readiness for change and develop a theory of its determinants and outcomes. In contrast to much of the literature on the topic, the conceptual definition offered here treats organizational readiness as a shared team property--that is, a shared psychological state in which organizational members feel committed to implementing an organizational change and confident in their collective abilities to do so. This way of thinking about organizational readiness is best suited for organizational changes where collective, coordinated behavior change is necessary in order to effectively implement the change and, in some instances, for the change to produce anticipated benefits. Some of the most promising organizational changes in healthcare delivery require collective, coordinated behavior change by many organizational members. Electronic health records, chronic care models, open access scheduling, quality improvement programs, and patient safety systems are but a few examples. There are, however, many evidence-based practices that providers could adopt, implement, and use on their own with relatively modest training or support (e.g., smoking cessation counseling, foot exams for diabetic patients). Often such practices can generate benefits for individual providers, or their patients, regardless of whether other providers also adopt, implement, or use them. Individual-level theories of behavior change--such as the theory of planned behavior or the trans-theoretical model of change--apply more readily to such cases than organization-level theories do because the adoption, implementation, use, and outcomes of such evidence-based practices do not depend on collective, coordinated behavior change. The greater the degree of interdependence in change processes and outcomes, the greater the utility of supra-individual theories of readiness, such as the one presented here.
The article makes three contributions to theory and research. First, the article's discussion of the meaning of organizational readiness addresses a fundamental conceptual ambiguity that runs through the literature on the topic: is readiness a structural construct or a psychological one? The theory that I describe seeks to reconcile the structural view and psychological view by specifying a relationship between them. In this theory, resources and other structural attributes of organizations do not enter directly into the definition of readiness. Instead, they represent an important class of performance determinants that organizational members consider in formulating change efficacy judgments. This view is consistent with Bandura's [21
] contention that efficacy judgments focus on generative capabilities--that is, the capability to mobilize resources and orchestrate courses of action to produce a skillful performance. Thus, organizations with the same resources, endowments, and organizational structures can differ in the effectiveness with which they implement the same organizational change depending on how they utilize, combine, and sequence organizational resources and routines. It seems preferable to regard organizational structures and resource endowments as capacity to implement change rather than readiness to do so. This distinction between capacity and readiness could move theory and research forward by reducing some of the conceptual ambiguity in the meaning and use of the term 'readiness.'
Second, the article's discussion of determinants illuminates the theoretical basis for the various strategies that change management experts recommend for creating organizational readiness. For practitioners, it might not seem necessary to explain in theoretical terms how or why a strategy works. For researchers, however, theoretical explication of the pathways through which these strategies affect readiness is important for advancing scientific knowledge. The theory that I propose suggests that strategies such as highlighting the discrepancy between current and desired performance levels, fomenting dissatisfaction with the status quo, creating an appealing vision of a future state of affairs increase organizational readiness for change by increasing change valence--that is, by increasing the degree to which organizational members perceive the change as needed, important, or worthwhile. In addition to advancing scientific knowledge, identifying and testing the pathways through which actions (strategies) have effects can have practical implications as well. Such efforts can prompt the discovery of new strategies or alternative pathways, or they can show the equifinality of already known strategies. For example, in the theory that I describe, the keys to increasing readiness are raising change valence and promoting a positive assessment of task demands, resource availability, and situational factors. It seems unlikely that there is one best way to achieve these goals; at the same time, it seems unlikely that all ways are always equally effective. Creating a sense of urgency might be useful for increasing change valence in some situations (i.e., when complacency is high), but not others (i.e., when uncertainty is high). Likewise, end-user involvement in change design and implementation planning can be a powerful way for not only increasing change valence (e.g., helping people to see why this change is needed, important, and worthwhile), but also for helping organizational members realistically appraise the match of task demands, available resources, and situational factors. When, for whatever reason, end-user involvement is not an appropriate or feasible strategy, vicarious learning strategies (e.g., site visits) could be useful for supplying organizational members with accurate information about task demands, resource requirements, and situational factors affecting implementation. If readiness-enhancing strategies are indeed equifinal--and this is an empirical question--then organizational leaders, innovation champions, and other change agents could take with a grain of salt the 'one best way' advice so often found in prescriptive change management writing, and focus instead of developing and using strategies that are tailored to local needs, opportunities, and constraints.
Third, the article's discussion of outcomes develops a theoretical link between two disparate bodies of research: organizational readiness for change and implementation theory and research. As noted earlier, change experts have asserted that greater organizational readiness leads to more successful implementation without specifying what 'successful implementation' means or explaining how or why this might be so. This article uses implementation theory to conceptually define the notion of implementation effectiveness and distinguish implementation effectiveness from innovation effectiveness. Moreover, the article draws on social cognitive theory and motivation theory to explain how greater organizational readiness could result in more effective change implementation. Implementation theory could also benefit from a stronger theoretical link. Although it is beyond the scope of this article to discuss in detail, I suspect that the construct of implementation climate--which Klein and Sorra [55
] define as organizational members' shared perception that innovation use is expected, supported, and rewarded--has much in common with organizational readiness for change, the principal difference being that one construct applies in the 'pre-implementation' period while the other applies once implementation has begun. This article merely begins the dialogue between these two bodies of research which hitherto have developed independently of one another. Whether or not the theory developed here ultimately finds empirical support, I hope that its discussion promotes scholarly debate and stimulates empirical inquiry into an important, yet under-studied topic in implementation science.