Organizational Readiness to Change Assessment (ORCA) tool

Description

This tool measures organizational readiness to implement evidence-based practices in clinical settings. The Organizational Readiness to Change Assessment (ORCA) instrument consists of three major scales that measure:

• strength of the evidence for the proposed change/innovation;
• quality of the organizational context to support the practice change; and
• organizational capacity to facilitate the change.

The ORCA tool was developed from the Promoting Action on Research Implementation in Health Services (PARIHS) framework, a theoretical model to guide implementation of evidence-based interventions. The ORCA instrument operationalizes the constructs defined in the PARIHS framework.

The tool consists of 77 items, with subscales, grouped according to the main areas of the PARIHS framework:

• Evidence: the nature and strength of the evidence and its potential for implementation (4 subscales)
• Context: the environment or setting in which the proposed change is to be implemented (6 subscales)
• Facilitation: capacity or types of support needed to help people change their attitudes, behaviours, skills and ways of thinking and working (9 subscales)

Steps for Using Method/Tool

The Organizational Readiness to Change Assessment (ORCA) tool consists of 77 items in the following scales:

1. Evidence Assessment:

• Amount of discord within the practice team about evidence (the extent to which a respondent sees colleagues concluding a weaker or stronger evidence base than the respondent)
• Research evidence
• Clinical experience
• Patient preferences

2. Context Assessment:

• Senior leadership culture
• Staff culture
• Leadership behaviour
• Measurement (leadership feedback)
• Opinion leaders
• General resources

3. Facilitation Assessment (to assess the organization's capacity for internal facilitation to support change):

• Senior leaders practices
• Champion characteristics
• Leadership implementation roles
• Implementation team roles
• Implementation plan
• Project communication
• Project progress tracking
• Project resources and context
• Project evaluation

Evaluation

The authors conducted two sets of psychometric analyses on data from three quality improvement projects conducted in the Veterans Health (VA) Administration between 2002 and 2006. In each project, the ORCA instrument was administered to staff. Two sets of psychometric analyses were conducted:

1) item analysis to determine if items within scales correlate as predicted (reliability)

2) exploratory factor analyses of aggregated subscales to determine how many underlying factors may be present, and their relationships to each other (validity)

Also, Hagedorn and Heideman (2010) tested the utility of the ORCA tool in a clinical setting, where the ORCA was used at baseline and after implementation of hepatitis prevention services in substance use disorders (SUD) clinics. This study provides preliminary support of ORCA as a measure of organizational readiness to change.

Validity

Exploratory factor analysis applied to the aggregated subscale scores support three underlying factors, with the majority of subscale scores clustered according to the core elements of the PARIHS framework. However, subscales measuring champion characteristics and availability of resources failed to load significantly on any factor, and the leadership practices subscale loaded on context rather than facilitation.

Reliability

Reliability tests indicate that most subscales of the ORCA tool meet standard requirements of 0.80. Cronbach's alpha for reliability for the scales were 0.74, 0.85 and 0.95 for the evidence, context and facilitation scales, respectively. However, reliability was poor for three evidence subscales.