Introduction

Continual innovation to address emerging population needs necessitates health service ongoing redesign and transformation worldwide. Recent examples include service transformations in response to covid-19. The pandemic has catalysed several changes to how healthcare is delivered, particularly in the rapid acceleration of virtual and hybrid models of care.(1) As work processes, systems and models of care shift in response to health system needs, so too must individual and collective behaviours of the workforce and its consumers.(2, 3) Ensuring effective change management processes occur is therefore central to transformative changes that deliver their intended outcomes and are sustained. Yet change management is notoriously challenging in healthcare contexts, with limited evidence available for healthcare managers to optimise their implementation of current change management models.
Achieving ‘change readiness’ amongst healthcare staff is identified as an important precursor to whether staff accept and adopt a change initiative. Change readiness is influenced by the extent to which staff perceive that a given change is needed (their commitment to the change) and that they have the required capability and support to work in a new way (change self-efficacy).(1)(4, 5) Commitment to change arises for three reasons: a) because there is a requirement to support the change due to recognition of cost associated with failure to do so (continuance commitment), b) because there is a sense of obligation to support the change (normative commitment), and c) because an individual wants or desires to support the change due to the benefits associated with it (affective commitment).(6, 7)
Recent evidence indicates that affective commitment to change is an important contributor to achieving change readiness but understudied in relation to healthcare projects.(8-10) A systematic review of 38 studies of healthcare change projects highlights that management approaches rarely focus on the influence of affective commitment to change.(11) Our analysis sought to address the evidence gap regarding the association between affective commitment to change and change readiness in healthcare by exploring change readiness amongst clinical and non-clinical staff directly involved in one of four transformational change projects in New South Wales, Australia.