Low levels of ‘organizational readiness’ could be holding back lung cancer screening programs

Low levels of “organizational readiness” may be preventing the proliferation of lung cancer screening, according to a new analysis published Monday.

Wide-scale deployment of low-dose CT to diagnose the disease is sorely lacking, with one recent study estimating that only 3.2% of eligible patients receive it. Experts recently set out to better understand these numbers, publishing their findings in the American Journal of Preventive Medicine [1].

Public health researchers surveyed radiology and primary care providers, along with staff and hospital leaders, across 10 Veterans Affairs medical centers. They unearthed key clues to help improve the uptake of LDCT.

“This study found that higher levels of organizational readiness among clinicians and staff were positively associated with utilization, but that leaders' levels of organizational readiness were negatively associated with utilization,” Jennifer A. Lewis MD, MPH, a medical oncologist and assistant professor with Vanderbilt University Medical Center, and co-authors wrote May 22. “These results are hypothesis-generating and suggest that interventions, especially at the clinician and staff levels, may translate into improved implementation of lung cancer screening.”

Researchers conducted their survey between 2018-2021, receiving a total of 956 completed questionnaires (a 27% response rate). The breakdown included 35% clinicians, 61% staff and 4% leaders. Sites volunteered to participate as part of the VA Partnership to Increase Access to Lung Screening national program. Investigators measured the study’s key variable using Shea’s validated Organizational Readiness for Implementing Change, or ORIC, and valence scales. The latter gauges employees’ belief that pursuing change is beneficial and valuable to the organization.

Lewis et al. discovered that, for each 1-point increase in median ORIC and change valence, there was a corresponding 8.4 percentage-point and 6.5 percentage-point increase in low-dose CT utilization, respectively. Higher clinician and staff scores were associated with upticks in LDCT use, while leader scores were tied to decreases.

“Contrary to prior work on organizational change that emphasizes the outsize importance of leader commitment or executive champions, this study found that the change readiness of clinicians and staff (rather than leaders) was associated with higher utilization of lung cancer screening,” Lewis and co-authors noted. “This finding suggests the importance of staff and clinician readiness for change and their belief in its value for successful implementation of change/adoption of evidence-based programs, policies or practices. This work points to the need for research on when and how leader readiness for change matters as well as the relationship between leader and clinician/staff readiness for change. Middle managers also play an important role in implementation of evidence-based practices and understanding their organizational readiness as it relates to clinical outcomes is an area deserving of future exploration.”

The authors were uncertain why some VA sites appeared more prepared for change than others. Possible influencing factors could include differences in communication or structural reasons such as regular huddles, meetings or ongoing quality improvement. Their findings underscore the importance work to understand these barriers and facilitators of screening at each site, the authors wrote.

“Implementing new evidence-based clinical practices is challenging,” they added. “Thoroughly assessing readiness for change can help identify challenges to implementation and point to interventions more carefully attuned to the strengths and barriers at each site. The study findings suggest that future efforts should focus on assessing and increasing organizational readiness for change in lung cancer screening.”

Read much more at the link below.