BACKGROUND Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. METHODS Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. RESULTS The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals' evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. CONCLUSIONS Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.

中文翻译：

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检查卫生保健提供者和中层管理者对变革的准备程度：定性研究。

背景技术就绪是成功变革的关键先决条件。它表示参与变更的人员是否有动力并有权参与变更。对准备情况的研究往往集中于一线提供者或非管理职位的人员，而对中层管理职位的人员的关注有限，这些人员有望在变更实施方面领先一线提供方。然而，中层管理人员也可以接受高层职位人员计划和颁布的变更。这项研究试图检查一线医疗服务提供者和中层管理人员是否准备好在初级保健计划整合的背景下进行变革。方法采用定性案例研究方法，我们检查了前线提供者和中层管理者如何经历六个准备就绪因素：差异，适当性，效价，功效，公平和对管理的信任。通过文档，会议观察以及与参与变更的一线提供商和中层管理人员进行的半结构化访谈来收集数据。结果调查结果突显了一线服务提供商和中层管理人员在准备工作方面的异同。在这两种类型的参与者中，我们发现效价的概念应扩展到考虑个人对患者和卫生系统的收益评估。效力适用于变更的内容和过程；对管理发现的公正性和信任需要进一步探索，以确定将其适当性纳入变革准备模型中；对管理的信任（或缺乏信任）在组织的各个级别上都有级联影响。结论我们的研究通过细化和扩展个人准备就绪因素的概念化，并着重强调了中层管理人员为变革做好准备的核心作用，从而做出了贡献。该研究的意义包括在实施变更之前需要考虑准备因素，以及在整个组织的各个层面促进准备的重要性。