Organizational readiness to change (ORC) is a fundamental concept within the field of organizational development and has been operationalized in substance misuse treatment. The aim of this review was to describe the relationship between staff perceptions of ORC and outcomes in substance misuse treatment services. This systematic review adhered to PRISMA guidelines. Eight papers were identified for inclusion. All papers utilized the same tool or a modified version of the same tool to measure ORC. Four of these papers used the same tool to measure client outcomes. The quality of the included papers was fair, and the level of evidence was low in respect of evidential hierarchy. ORC is predictive how effectively programs can deliver treatment. Positive ORC measurements relate to better staff/client relationships, reduced substance misuse, and better overall treatment engagement. Effectively resourced programs are more likely to have a more favorable ORC assessment, but resources are not the only determinant. Staff dynamics are important, and having a good organizational climate is of particular importance. There is limited evidence available on how to address ORC deficits. Understanding which organizational attributes are more effective than others could provide important information for policy makers and planners, but more evidence is required.