Ready, set, go!: exploring use of a readiness process to implement pharmacy services

BACKGROUND: Readiness is an essential precursor of successful implementation; however, its conceptualization and application has proved elusive. R = MC(2) operationalizes readiness for use in practice. The purpose of this study was to (1) describe the application of R = MC(2) to assess and build readiness in nine healthcare sites responsible for implementing medication management services and (2) gain insights into the sites’ experience. METHODS: This mixed methods exploratory study used data collected as part of a process evaluation. Understanding application of the readiness process (Aim 1) involved examining team members’ involvement (who?), readiness challenges and readiness building strategies (what?), strategy execution (how much?), and resulting changes (for what purpose?). To understand the sites’ experience with the R = MC(2) system (Aim 2), interviews were conducted with six of the sites to identify facilitators, barriers, and lessons learned. Data sources included a document review (e.g., sites’ action plans), survey results, and interview data. RESULTS: Sites included primary care and specialty clinics, pharmacies within health systems, and community pharmacies. Teams consisted of 4–11 members, including a lead pharmacist. The teams’ readiness activities clustered into five broad categories of readiness building strategies (e.g., building the operational infrastructure for service integration). Of the 34 strategies identified across sites, 68% were still in progress after 4 months. Engaging in the readiness process resulted in a number of outputs (e.g., data management systems) and benefits (e.g., an opportunity to ensure alignment of priorities and fit of the intervention). Based on the interviews, facilitators of the readiness process included assistance from a coach, internal support, and access to the readiness tools. Competing priorities and lack of resources, timely decision-making, and the timing of the readiness process were cited as barriers. The importance of service fit, stakeholder engagement, access to a structured approach, and rightsizing the readiness process emerged as lessons learned. CONCLUSIONS: These findings provide valuable insights into the application of a readiness process. If readiness is to be integrated into routine practice as part of any implementation effort, it is critical to gain a better understanding of its application and value.