# Evidence and sources

Research checked 10 September 2026 using the Firecrawl paper index and online publisher, PubMed and university sources. This is a focused research synthesis, not a preregistered systematic review. The ten workflows, templates, thresholds and examples are original practical designs. No study evaluates this pack or these AI prompts.

## What the evidence supports—and does not

Define the action before designing support. Diagnosis should examine skills, tools, opportunity and competing demands instead of assuming unwillingness. Current intervention reviews support modest, variable improvements from tailored support and feedback in healthcare; they do not establish an effect size for agency workflow changes. Readiness and participation are useful questions, but neither is a guarantee. The pack therefore treats readiness as a discussion of conditions, requires a baseline and harm checks, and keeps stopping or adapting open.

A pilot gives local learning. Without a credible comparison it cannot establish that the change caused the result. Measure actual use separately from intended benefit and burden. A process can achieve high compliance while harming quality. Adaptations should preserve the intended function where justified, and remain testable as context changes.

## Academic source ledger

Access labels describe what was actually retrieved: **body** means relevant full-text sections; **abstract** means abstract or author/publisher summary only; **record** means bibliographic record and limited retrieved passages. Source links do not imply endorsement.

| ID and reference | Evidence and access | Finding, limitation and use |
|---|---|---|
| E1. Michie, van Stralen & West (2011). *The behaviour change wheel: A new method for characterising and designing behaviour change interventions*. Implementation Science 6:42. [DOI](https://doi.org/10.1186/1748-5908-6-42) | Framework synthesis; body | Capability, opportunity and motivation organize barrier questions. A design framework is not proof that a selected intervention works. Supports behavior brief and barrier diagnosis. |
| E2. Weiner (2009). *A theory of organizational readiness for change*. Implementation Science 4:67. [DOI](https://doi.org/10.1186/1748-5908-4-67) | Theory; body | Distinguishes shared commitment and efficacy. Theoretical propositions do not justify a validated readiness threshold. Supports capacity check. |
| E3. Miake-Lye et al. (2020). *Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments*. BMC Health Services Research 20:106. [DOI](https://doi.org/10.1186/s12913-020-4926-z) | Systematic instrument review; abstract and publisher record | Instruments emphasize internal context and vary in content. Supports explicit conditions rather than an improvised readiness score; healthcare transfer limit. |
| E4. Caci et al. (2025). *Organizational readiness for change: A systematic review of the healthcare literature*. Implementation Research and Practice 6. [DOI](https://doi.org/10.1177/26334895251334536) | Systematic review; body | Forty-seven studies used diverse definitions and measures; most measured readiness once and most were observational. The precise role remains unclear. Supports repeated practical checks and restraint about causality. |
| E5. Damschroder et al. (2022). *The updated Consolidated Framework for Implementation Research based on user feedback*. Implementation Science 17:75. [DOI](https://doi.org/10.1186/s13012-022-01245-0) | Framework update from literature and user feedback; abstract/PDF opening | Context must be examined across settings and implementation participants. This is a determinant framework, not an effect estimate or compulsory checklist. Supports diagnosis and transfer review. |
| E6. McHugh et al. (2026). *Tailored interventions to address determinants of practice*. Cochrane Database of Systematic Reviews 2:CD005470. [DOI](https://doi.org/10.1002/14651858.CD005470.pub4) | Review of randomized trials; abstract and official summary | Tailoring probably produces slight improvements in professional practice; approaches and settings vary. Optimal tailoring remains uncertain; mostly high-income healthcare. Supports selecting support against verified barriers. |
| E7. Ivers et al. (2026). *Audit and feedback: effects on professional practice*. Cochrane Database of Systematic Reviews 6:CD000259. [DOI](https://doi.org/10.1002/14651858.CD000259.pub5) | Review of trials; official summary/conclusions | Feedback can improve practice, with variable effects and co-interventions. Design moderators need confirmation. Supports actionable work feedback, not surveillance or guaranteed effects. The pack's aggregate measurement choice is an ethical/practical design decision, not a claim that it maximizes effects. |
| E8. Taylor et al. (2014). *Systematic review of the application of the plan–do–study–act method to improve quality in healthcare*. BMJ Quality & Safety 23:290–298. [DOI](https://doi.org/10.1136/bmjqs-2013-001862) | Systematic methods review; abstract and indexed body excerpts | Reporting often missed central features of iterative testing; the review is not a pooled demonstration of PDSA effectiveness. Supports explicit predictions, small tests, repeated measures and documented revisions. |
| E9. Proctor et al. (2011). *Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda*. Administration and Policy in Mental Health 38:65–76. [DOI](https://doi.org/10.1007/s10488-010-0319-7) | Conceptual synthesis; body | Distinguishes implementation outcomes from service/clinical outcomes and identifies measurement issues. Supports separate uptake, usefulness and cost fields; original workplace adaptation. |
| E10. Oreg, Vakola & Armenakis (2011). *Change recipients’ reactions to organizational change: A 60-year review of quantitative studies*. Journal of Applied Behavioral Science 47:461–524. [DOI](https://doi.org/10.1177/0021886310396550) | Review of 79 quantitative studies; abstract and author-hosted opening | Reactions relate to change content, process, context and perceived harm/benefit. Associations do not establish a universal communication recipe. Supports involvement and honest attention to losses. |
| E11. Oreg & Sverdlik (2026). *Responses to Organizational Change: Evolution of the Concept, Established Findings, and Future Directions*. Annual Review of Organizational Psychology and Organizational Behavior 13:387–413. [DOI](https://doi.org/10.1146/annurev-orgpsych-020924-064623) | Research review; abstract and indexed body excerpts | Response activation, ambivalence and timing deserve attention. Supports revisiting concerns instead of treating people as fixed “resisters.” Not a test of this pack. |
| E12. Jakobsen, Clausen & Andersen (2020). *Can a participatory organizational intervention improve social capital and organizational readiness to change? Cluster randomized controlled trial at five Danish hospitals*. Journal of Advanced Nursing 76:2685–2695. [DOI](https://doi.org/10.1111/jan.14441) | Cluster trial; abstract | No group-by-time interaction on the measured outcomes; exploratory within-group improvements do not establish intervention superiority. Counterevidence to claiming participation guarantees readiness. Supports honest involvement plus outcome checks. |
| E13. Wiltsey Stirman, Baumann & Miller (2019). *The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions*. Implementation Science 14:58. [DOI](https://doi.org/10.1186/s13012-019-0898-y) | Reporting framework; body | Records what changed, why, when and who decided, including relation to fidelity. Documentation does not prove an adaptation beneficial. Supports adaptation notes and version history. |
| E14. Chambers, Glasgow & Stange (2013). *The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change*. Implementation Science 8:117. [DOI](https://doi.org/10.1186/1748-5908-8-117) | Conceptual framework; abstract | Sustaining useful work may require continuing fit and learning as context changes. Theory rather than causal proof. Supports maintenance, adaptation and retirement review. |

## Design decisions

The specific ten-skill sequence, output fields, AI interaction, local thresholds, suggested review dates and fictional cases are our synthesis. Their usefulness must be checked in use. We deliberately avoid a single readiness score, a universal change-failure percentage, “resistance” labels and the assumption that training or communication can solve workload constraints.

The healthcare-heavy intervention evidence is a substantive limitation. Agency client demands, billable work and small teams may change both feasibility and effects. Use transparent local observation and consultation. Small group reporting should not expose individuals. Do not interpret worker objections as a psychological diagnosis.