What to do if the organization or site is not ready for change

By Dr. Julia Moore , Executive Director, The Center for Implementation

When the pandemic started, “adaptations” was the word on everyone’s minds. At the time, almost every conversation we had touched on issues related to adaptations: How can fidelity be balanced with the reality change initiatives would have to be delivered in a totally different way (e.g., virtually instead of in person)? Was it possible to maintain the underlying function or mechanism of change when making what felt like dramatic adaptations? How could the science of implementation be used to plan and evaluate these adaptations?

A few years later, conversations have shifted. The theme we’ve seen emerge is that no one is ready for more change. Staff are exhausted, overwhelmed, maxed out, and burned out. Leadership is reluctant to push new changes and implementation efforts. They are struggling to balance the need for change with the challenges staff are experiencing, exacerbated by the fact that they themselves are often facing many of the same challenges.??

It feels to us as if there is a collective reluctance for change, greater than anything we’ve seen in our implementation careers.?

At the same time, there’s currently a huge amount of change happening for individuals, organizations, and across the system. For example, people are navigating multiple types of work-related changes, like returning to the office, hybrid work, permanently working from home, role changes, job changes, new leadership, shifting mental models about the way we work, what we value, and what we focus on. So, while many of us may be craving a level of stability without change, that is rarely the reality today.

As a result, the number one question we have been receiving these days is, “What do we do if people and organizations are not ready for change?”

1. Assess readiness for change

While there is a collective lack of readiness for change at the moment, the reasons for the reluctance to embrace change differ based on the context. Don’t assume you know whether or not an organization, site, group, or team is ready for change without first connecting with them and asking them.

Part of this process of assessing readiness is also to delve into why people are or are not ready right now.?Your next steps involve addressing readiness for change and should ideally be based on the underlying challenges that people are experiencing. Therefore, you need to deeply understand what those challenges are.

2. Check if the implementation team and implementation support practitioners are ready

Because issues with readiness for change are currently happening at every level in many contexts, the people supporting implementation are also struggling. We co-hosted an event with the Collaborative for Implementation Practice and the Jordan Institute at the UNC School of Social Work about the challenges being faced by implementation support practitioners, with a focus on burnout and resilience. Over 1100 people registered for the event (a recording is available if you would like to check it out), which helps to demonstrate how relevant this topic is to people’s experiences right now.

We’ve been hearing that many implementation support practitioners and implementation teams are not only struggling themselves but also struggling to support change in organizations and that are not currently embracing those changes.?

What can you do? Check-in with the implementation team and those implementation support practitioners (they have a range of job titles, but these are the people who are supporting implementation to happen). If you are an implementation support practitioner, reach out to others. We know that many implementation support practitioners feel very isolated and alone, but your struggles are being experienced by many, so find people to connect with to help support each other.?

A resource you could explore is our Implementing Change Community, which we created for this very purpose of having a supportive community to turn to. ?

3. Don't move forward with implementation without first addressing readiness

It’s not uncommon for implementation teams to feel pressured to rush into implementation, despite knowing that there is a lack of readiness for change. You are not setting yourself up for success if you move forward with implementation before the stage is set.

Sometimes, following a readiness assessment, you might discover that a site is not quite ready to move forward with implementation right away. This is an opportunity to support the site to build readiness so that when they move forward with implementation, they have set the stage to achieve their desired outcomes.

While it might be tempting (or you may even feel pressured) to move forward with sites that are “less ready,” this is not likely to lead to a successful and positive implementation experience. The impact of that might be further reaching than you first anticipate. For example, those sites might be less eager to take on another change initiative in the future.

In other situations, you might have sites that are “not ready.” For example, this might occur when there is a mismatch between the proposed change and the site (i.e., the change initiative is not a good fit for the site). If this is the case, it’s also very important to not just ignore this information. Pause, reflect, and reassess the best path forward.

4. Consider the equity implications of prioritizing sites that are more ready

Given the collective lack of readiness, it might be tempting to prioritize sites or settings that are more ready and move forward with implementation there. This is a fairly common practice in the field of implementation science. But prioritizing sites that are already ready is likely to further perpetuate inequities in a system.?

Sites or organizations that are “more ready” may also be performing better in many different ways, and may not need the proposed change as much as other sites that are “less ready.” Prioritizing these “more ready” sites may further perpetuate inequities in terms of access and outcomes.

5. Develop readiness building strategies

How do we address issues of readiness if we don’t want to just prioritize sites that are already ready? That’s where readiness building strategies come in. We also refer to these as “pre-implementation strategies.” These are strategies that you can use to address underlying readiness issues in order to make a site more ready for change. Readiness building strategies might help with a specific change initiative, but they often help with all change initiatives since readiness is actually comprised of both general readiness for change (i.e., whether a site is ready for change in general) and initiative-specific readiness (i.e., whether or not a site is ready for one specific initiative).?

We can use the same process that we use to design initiatives (our StrategEase Pathway) to develop readiness building strategies. This involves understanding the current level of readiness (by assessing readiness) and then tapping into the root causes that are contributing to this lack of readiness. We can then select WHAT needs to be done differently to address these underlying causes and assess the barriers and facilitators to doing these things differently. Finally, we can select strategies (the HOWs) that address those underlying barriers to change.

Because the issue of readiness has become so pervasive, we have pivoted some of our own work to build out a readiness building strategy, specifically to address burnout. The strategy is still in its early development stages, but we are sharing this to encourage others to be open to pivoting your own implementation plans to address current —?and most pressing — needs.

Want to strengthen how you assess readiness and context, as well as how to consider and address contextual barriers? Our course Implementation, Spread, and Scale is coming back with exciting new updates! Opening for enrollment March 21, 2023!

Note: An earlier version of this article originally appeared in the June 2022 issue of our Implementation in Action bulletin. Subscribe here to receive our next issue.