Perceptions of Organisational Readiness for Change in Nurse- and Midwifery-Led Quality Improvement Initiatives

Abstract

Introduction: Perceived organizational readiness is vital to nurses’ and midwives’ success in leading quality improvement, yet little is known about their perceptions. This study assessed perceived organizational readiness for change among 30 nurse and midwife leaders in leading quality improvement projects following a 9-month academic leadership fellowship with the Global Leadership in Nursing and Midwifery program at the University of Global Health Equity, Kigali, Rwanda. Methods: Using a quantitative cross-sectional design, we assessed sociodemographic characteristics and perceived organizational readiness of nurses and midwives who had implemented a quality improvement initiative at their workplace following the training. Participants completed the original, validated Organizational Readiness for Implementing Change (ORIC) questionnaire, which assesses perceived readiness, commitment, and efficacy, demonstrating high reliability (Cronbach’s α =0.96). Data analysis was facilitated by RStudio and summarized using descriptive statistics. Results were presented in tables and charts to illustrate readiness levels across participants. Results: Only 50% of the nurses and midwives perceived their organization as being supportive. There was an overall moderately to high perceived readiness score of 49 out of 60, with a higher median perception of change efficacy of 29 out of 35 among the nurses. The nurses had a lower agreement on their organizational motivation, organizational ability to get people to invest in change, and the ability to navigate internal politics. Prior experience with implementing QI in their organization, and perceived organizational supportive cultures were associated with higher readiness scores. Conclusion: While training enhances nurses and midwifery leaders’ confidence in leading QI initiatives, their implementation and sustainability require more than individual capability. Organizational commitment by ensuring supportive structures and resource alignment is essential. Leadership can operationalize readiness by fostering nurse leadership development and supportive environments that address systemic barriers. These findings advance nursing and midwifery leadership frameworks and inform future readiness assessments in healthcare.