Method

Ethical approval: This study was approved by Western New South Wales Local Health District Human Research Ethics Committee (Approval number 2020/ETH01247)
Design : Cross sectional survey
Survey instrument: A survey tool was developed by the research team consisting of five elements (Supplementary File A). The responses were measured on a 7-point Likert scale (from 1- strongly disagree to 7 - strongly agree). The four validated elements were: i) Individual change readiness scale (4 items) , ii) collective change readiness scale (4 items), iii) change self-efficacy scale (4 items), and iv) affective commitment to change scale (3 items).(6, 13) A fifth element contained purposively developed items to assess participants understanding and awareness of the change being proposed.
Setting : The study was conducted in partnership between academic researchers, health agencies and two local health districts (LHDs) in New South Wales, Australia. Two local health districts (LHDs) in New South Wales participated in this study, one servicing a metropolitan region and one servicing a rural/remote region. Within each district the project partners identified two transformational change projects that were at a suitable stage to address our aims. This meant that projects were of a similar scale, at a similar point in their planning, but implementation had not yet commenced. The four participating projects were: virtual pharmacy project, in-home monitoring project, emergency department expansion and an outpatient administration change project.
Recruitment and procedure : Employees in any clinical or non-clinical role who were directly affected by or involved in the change/s proposed in each project were eligible to participate: a total participant pool of 60 participants was available who met the eligibility criteria in the participating projects. A minimum sample size of 15 participants per site was sought to enable us to detect significant changes in individual change readiness between sites.(14) Participants were recruited via a study invitation email with an embedded survey link. The email was distributed by the research team to eligible potential participants at each site through the local study partners. Written consent was obtained from individuals prior to their participation.
Analysis : Descriptive and inferential statistics for sample characteristics and the levels of change readiness, change commitment, and change self-efficacy were explored using SPSS (IBM Statistics, Version 25). Pearson correlation coefficients were calculated to examine the relationships between readiness for change (individual and collective), change self-efficacy, and affective commitment to change. Multiple regression analysis using ordinary least square estimation was conducted to examine the independent effects of the two antecedents (affective commitment to change and change self-efficacy) on individual change readiness. Specifically, we conducted a simultaneous regression in which change readiness was entered as the outcome variable and change self-efficacy and affective commitment to change were entered as predictors.