DOI: 10.1097/js9.0000000000000888 ISSN: 1743-9159

A practical tool for managing change: Cross-sectional psychometric assessment of the safe surgery organizational readiness tool

Tuna Cem Hayirli, John G. Meara, Egide Abahuje, Barnabas Alayande, Sylvio Augustin, David Barash, Adeline A. Boatin, Albino Kalolo, James Kengia, Paul Kingpriest, Innocent Kissima, Edwin R. Lugazia, Christophe Mpirimbanyi, Joseph Ngonzi, Abdoulie Njai, Victoria L. Smith, Ntuli Kapologwe, Shehnaz Alidina
  • General Medicine
  • Surgery


Strengthening health systems through planned safety and quality improvement initiatives is an imperative to achieve more equitable, resilient, and effective care. And yet, years of organizational behavior research demonstrate that change initiatives often fall short because managers fail to account for organizational readiness for change. This finding remains true especially among surgical safety and quality improvement initiatives in low- and middle-income countries. In this study, our aim was to psychometrically assess the construct validity and internal consistency of the Safe Surgery Organizational Readiness Tool (SSORT), a short survey tool designed to provide change leaders with insight into facility infrastructure that supports learning and readiness to undertake change.

Materials and Methods:

To demonstrate generalizability and achieve a large sample size (n=1,706) to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), a collaboration between seven surgical and anesthesia safety and quality improvement initiatives was formed. Collected survey data from health care workers were divided into pilot, exploration, and confirmation samples. The pilot sample was used to assess feasibility. The exploration sample was used to conduct EFA, while the confirmation sample was used to conduct CFA. Factor internal consistency was assessed using Cronbach’s alpha coefficient.


Results of the EFA retained 9 of the 16 proposed factors associated with readiness to change. CFA results of the identified 9 factor model, measured by 28 survey items, demonstrated excellent fit to data. These factors (appropriateness, resistance to change, team efficacy, team learning orientation, team valence, communication about change, learning environment, vision for sustainability, facility capacity) were also found to be internally consistent.


Our findings suggest that communication, team learning, and supportive environment are components of change readiness that can be reliably measured prior to implementation of projects that promote surgical safety and quality improvement in low- and middle-income countries. Future research can link performance on identified factors to outcomes that matter most to patients.

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