An Analysis of Features of Respiratory Therapy Departments That Are Avid For Change

BACKGROUND: Models of organizational change-readiness have been developed, but little attention has been given to features of change-avid health-care institutions, and, to our knowledge, no attention has been given to features of change-avid respiratory therapy (RT) departments.

METHODS: We conducted an exploratory study to compare RT departments we deemed change-avid or non-change-avid, to identify differentiating characteristics. Our assessments regarding change-readiness and avidity were based on structured, in-person interviews of the technical directors and/or medical directors of 8 RT departments. Based on a priori criteria, 4 of the 8 RT departments were deemed change-avid, based on the presence of ≥ 2 of the following 3 criteria: (1) uses a management information system, (2) uses a comprehensive RT protocol program, (3) uses noninvasive ventilation in > 20% of patients with exacerbation of chronic obstructive pulmonary disease. Our ratings of the departments were based on 2 scales: one from Integrated Organizational Development Inc, and the 8-stage change model of Kotter.

RESULTS: The ratings of the 4 change-avid departments differed significantly from those of the 4 non-change-avid departments, on both the Integrated Organizational Development Inc scale and the Kotter scale. We identified 11 highly desired features of a change-avid RT department: a close working relationship between the medical director and the RT staff; a strong and supportive hospital “champion” for change; using data to define problems and measure the effectiveness of solutions; using redundant types of communication; recognizing resistance and minimizing obstacles to change; being willing to tackle tough issues; maintaining a culture of ongoing education; consistently rewarding change-avid behavior; fostering ownership for change and involving stakeholders; attending to RT leadership succession planning; and having and communicating a vision for the department.

CONCLUSIONS: In this first exploratory study we found that change-avid RT departments can be differentiated from non-change-avid RT departments with available assessment tools. Highly desired features of a change-avid RT department were identified but require further study, as does the relationship between change-avidity and clinical outcomes.