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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Kim E, Duggan C, Helfrich C, Yoon H, Chue B, Moon AY, Ho E. A strategy to implement the American College of Sports Medicine's Exercise is Medicine® (EIM) initiative in a community oncology clinic. Support Care Cancer 2024; 32:156. [PMID: 38349581 DOI: 10.1007/s00520-024-08330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Despite proven benefits, few cancer patients exercise during chemotherapy. The American College of Sports Medicine's Exercise is Medicine® (EIM) initiative describes a model to integrate exercise into oncology care, based upon assessing patients' ability to exercise safely, advising on exercise benefits, and referring patients to exercise. We developed and tested a strategy to implement EIM in a community-based oncology clinic, to assess-advise-refer 20 patients undergoing chemotherapy to a 3-month online exercise class, and measured implementation outcomes. METHODS Using a community-based provider participation in research (CBPPR) model, researchers and staff co-designed and tested a 4-level implementation strategy, with a goal of assessing-advising-referring 20 cancer patients to exercise. Surveys and interviews were conducted with 12 (100%) staff at baseline and post-implementation on acceptability/appropriateness/feasibility, perceptions of individual implementation roles, and organizational strengths/conditions. Data were analyzed using correlations, t-tests, and content analysis. RESULTS The proposed strategy was revised in collaboration with staff who requested assistance for recruitment and data collection. EIM was successfully implemented with 41 (92%) patients assessed, 37 (90%) advised, and 22 (60%) referred to exercise classes. Barriers to implementation were staff shortages and time constraints; facilitators included research team supports. Staff's perceived organizational strengths were positively correlated with exercise promotion acceptability, appropriateness, and feasibility. There were no statistically significant changes in implementation outcomes (acceptability/appropriateness/feasibility) post-implementation. CONCLUSIONS Using a collaborative model, EIM was successfully implemented in a community oncology clinic; however, the clinic required significant support from the research team. Adaptations to the EIM process may be required to improve implementation outcomes.
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Affiliation(s)
- Eunjung Kim
- Child, Family and Population Health Nursing, University of Washington, Box 357262, Seattle, WA, 98195, USA.
| | - Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christian Helfrich
- Health System and Population Health, University of Washington, Seattle, WA, USA
- Veterans Administration Puget Sound Health Care System, Seattle, WA, USA
| | - Hyesang Yoon
- Child, Family and Population Health Nursing, University of Washington, Box 357262, Seattle, WA, 98195, USA
| | - Ben Chue
- Lifespring Cancer Treatment Center, Seattle, WA, USA
| | | | - Easter Ho
- Lifespring Cancer Treatment Center, Seattle, WA, USA
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Zhang Y, Cook C, Fallon L, Corbin C, Ehrhart M, Brown E, Locke J, Lyon A. The Interaction Between General and Strategic Leadership and Climate on Their Multilevel Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Cross-Sectional Study. Adm Policy Ment Health 2023; 50:427-449. [PMID: 36585557 DOI: 10.1007/s10488-022-01248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, The University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clay Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Lindsay Fallon
- Department of Counseling and School Psychology, University of Massachusetts-Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125, USA
| | - Catherine Corbin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- Department of Industrial/Organizational Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
| | - Eric Brown
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, 33124, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Aaron Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
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Potrebny T, Igland J, Espehaug B, Ciliska D, Graverholt B. Individual and organizational features of a favorable work environment in nursing homes: a cross-sectional study. BMC Health Serv Res 2022; 22:1244. [PMID: 36217149 PMCID: PMC9552400 DOI: 10.1186/s12913-022-08608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. METHODS This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. RESULTS 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. CONCLUSION The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.
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Affiliation(s)
- Thomas Potrebny
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Birgitte Espehaug
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Donna Ciliska
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Birgitte Graverholt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Smit LC, De Wit NJ, Nieuwenhuizen ML, Schuurmans MJ, Bleijenberg N. Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study. BMC Geriatr 2021; 21:578. [PMID: 34666699 PMCID: PMC8527676 DOI: 10.1186/s12877-021-02539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. METHODS A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. RESULTS A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). CONCLUSION Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.
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Affiliation(s)
- Linda C Smit
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, The Netherlands.
| | - Niek J De Wit
- Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Meggie L Nieuwenhuizen
- Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Nienke Bleijenberg
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, The Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, The Netherlands
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Knott CL, Chen C, Bowie JV, Mullins CD, Slade JL, Woodard N, Robinson-Shaneman BJR, Okwara L, Huq MR, Williams R, He X. Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches. Transl Behav Med 2021; 12:673-682. [PMID: 34255087 DOI: 10.1093/tbm/ibab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.
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Affiliation(s)
- Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Chang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Janice V Bowie
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | | | - Leonore Okwara
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Ralph Williams
- Access to Wholistic and Productive Living, Inc., Colmar Manor, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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Hearld L, Hall A, Kelly RJ, Karabukayeva A, Singh J. Organizational context and the learning and change readiness climate for implementing an evidence-based shared decision-making aid in US rheumatology clinics. J Health Organ Manag 2021; ahead-of-print. [PMID: 34232597 DOI: 10.1108/jhom-10-2020-0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine the organizational context that may support learning and change readiness climates that previous research has found to be conducive to implementing evidence-based interventions. DESIGN/METHODOLOGY/APPROACH An exploratory, mixed method evaluation that included 15 rheumatology clinics throughout the United States was performed. Quantitative data were collected using a web-based survey completed by 135 clinic members. Qualitative data were collected via semi-structured interviews with 88 clinic members. FINDINGS In general, clinics reported strong, positive learning and change readiness climates. More complex organizations (e.g. multispecialty, academic medical centers) with rational/hierarchical cultures and members with longer tenure were associated with less supportive learning and change readiness climates. The authors' findings highlight opportunities for organizational leaders and evidence-based intervention sponsors to focus their attention and allocate resources to settings that may be most susceptible to implementation challenges. ORIGINALITY/VALUE First, the authors address a deficit in previous research by describing both the level and strength of the learning and change readiness climates for implementing an evidence-based shared decision-making aid (SDMA) and examine how these vary as a function of the organizational context. Second, the study examines a broader set of factors to assess the organizational context (e.g. organizational culture, organizational structure, ownership) than previous research, which may be especially salient for shaping the climate in smaller specialty clinics like those we study. Third, the authors utilize a mixed methods analysis to provide greater insights into questions of how and why organizational factors such as size and structure may influence the learning and change readiness climate.
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Affiliation(s)
- Larry Hearld
- Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allyson Hall
- Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Reena Joseph Kelly
- Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aizhan Karabukayeva
- Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder Singh
- Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Schadewaldt V, McElduff B, D'Este C, McInnes E, Dale S, Fasugba O, Cadilhac DA, Considine J, Grimshaw JM, Cheung NW, Levi C, Gerraty R, Fitzgerald M, Middleton S. Measuring organizational context in Australian emergency departments and its impact on stroke care and patient outcomes. Nurs Outlook 2020; 69:103-115. [PMID: 32981669 DOI: 10.1016/j.outlook.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/22/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. PURPOSE To identify how context affects the provision of stroke care in 26 Australian EDs. METHOD Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. FINDINGS Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. DISCUSSION Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia.
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Julie Considine
- Deakin University - Eastern Health; School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Deakin University, Geelong, Victoria, Australia
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital - General Campus, Centre for Practice-Changing Research (CPCR), Ottawa, Ontario, Canada
| | - N Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Chris Levi
- The Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, New South Wales, Australia
| | - Richard Gerraty
- Department of Medicine, Monash University, Melbourne, Australia
| | - Mark Fitzgerald
- Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
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Müller J, Meneses J, Humbert AL, Guenther EA. Sensor-based proximity metrics for team research. A validation study across three organizational contexts. Behav Res Methods 2021; 53:718-43. [PMID: 32813224 DOI: 10.3758/s13428-020-01444-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wearable sensors are becoming increasingly popular in organizational research. Although validation studies that examine sensor data in conjunction with established social and psychological constructs are becoming more frequent, they are usually limited for two reasons: first, most validation studies are carried out under laboratory settings. Only a handful of studies have been carried out in real-world organizational environments. Second, for those studies carried out in field settings, reported findings are derived from a single case only, thus seriously limiting the possibility of studying the influence of contextual factors on sensor-based measurements. This article presents a validation study of expressive and instrumental ties across nine relatively small R&D teams. The convergent validity of Bluetooth (BT) detections is reported for friendship and advice-seeking ties under three organizational contexts: research labs, private companies, and university-based teams. Results show that, in general, BT detections correlated strongly with self-reported measurements. However, the organizational context affects both the strength of the observed correlation and its direction. Whereas advice-seeking ties generally occur in close spatial proximity and are best identified in university environments, friendship relationships occur at a greater spatial distance, especially in research labs. We conclude with recommendations for fine-tuning the validity of sensor measurements by carefully examining the opportunities for organizational embedding in relation to the research question and collecting complementary data through mixed-method research designs.
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Stadnick NA, Lau AS, Barnett M, Regan J, Aarons GA, Brookman-Frazee L. Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort. Adm Policy Ment Health 2019; 45:447-461. [PMID: 29101604 DOI: 10.1007/s10488-017-0835-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.
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Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
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11
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Andrew NE, Middleton S, Grimley R, Anderson CS, Donnan GA, Lannin NA, Stroil-Salama E, Grabsch B, Kilkenny MF, Squires JE, Cadilhac DA. Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study. Implement Sci 2019; 14:6. [PMID: 30658654 PMCID: PMC6339367 DOI: 10.1186/s13012-018-0849-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/07/2018] [Indexed: 01/19/2023] Open
Abstract
Background Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes. Methods This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined. Results A total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1 year. There was good reliability (∞ 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (μ 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (μ 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medication at discharge (62.5% vs. 52.0%). Staff from higher context hospitals were more likely to value medical and/or nursing leadership and stroke care protocols. Conclusions Overall organizational context, and in particular aspects of culture and social capital, are associated with the delivery of some components of evidence-based stroke care, offering insights into potential pathways for improving the implementation of proven therapies. Electronic supplementary material The online version of this article (10.1186/s13012-018-0849-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadine E Andrew
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Sunshine Coast Clinical School, The University of Queensland, Birtinya and Statewide Stroke Clinical Network, Queensland Health, Brisbane, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Natasha A Lannin
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Enna Stroil-Salama
- Australian Bronchiectasis Registry, Lung Foundation Australia, Brisbane, Australia
| | - Brenda Grabsch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia. .,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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12
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Portela MC, Lima SML, da Costa Reis LG, Martins M, Aveling EL. Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues. BMC Pregnancy Childbirth 2018; 18:459. [PMID: 30477475 PMCID: PMC6258487 DOI: 10.1186/s12884-018-2088-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention. METHODS A qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers. Individual interviews with doctors and nurses were conducted from July to October 2015. Semi-structured interviews sought to explore teamwork, coordination and communication, and leadership, being open to capture other contextual elements that could emerge. Interviews were recorded and transcribed, and the categories of analysis were identified and updated based on the constant comparative method. RESULTS Twenty-seven interviews were carried out. Extra-organizational context concerning the dependence of the maternity hospitals on primary care units, responsible for antenatal care, and on other healthcare organizations' services emerged from interviews, but the main findings of the study centered on intra-organizational context with potential to affect healthcare quality and actions for its improvement, including material resources, work organization design, teamwork, coordination and communication, professional responsibility vis-à-vis the patient, and leadership. A major issue was the divergence of physicians' and nurses' perspectives on care quality, which in turn negatively affected their capacity to work together. CONCLUSION Overall, the findings suggest that care on the maternity hospitals was fragmented and lacked continuity, putting at risk the quality. Redesigning work organization, promoting conditions for multi-professional teamwork, better communication and coordination, improving more systemic accountability/lines of authority, and investing in team members' technical competence, and fitness of organizational structures and processes are all imbricated actions that may contribute to obstetric care quality improvement.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Lenice Gnocchi da Costa Reis
- Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA USA
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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13
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van der Lippe T, Lippényi Z. Beyond Formal Access: Organizational Context, Working From Home, and Work-Family Conflict of Men and Women in European Workplaces. Soc Indic Res 2018; 151:383-402. [PMID: 33029037 PMCID: PMC7505867 DOI: 10.1007/s11205-018-1993-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 05/28/2023]
Abstract
Working from home has become engraved in modern working life. Although advocated as a solution to combine work with family life, surprisingly little empirical evidence supports that it decreases work-family conflict. In this paper we examine the role of a supportive organizational context in making working from home facilitate the combination of work and family. Specifically, we address to what extent perceptions of managerial support, ideal worker culture, as well as the number of colleagues working from home influence how working from home relates to work-family conflict. By providing insight in the role of the organizational context, we move beyond existing research in its individualistic focus on the experience of the work-family interface. We explicitly address gender differences since women experience more work-family conflict than men. We use a unique, multilevel organizational survey, the European Sustainable Workforce Survey conducted in 259 organizations, 869 teams and 11,011 employees in nine countries (Bulgaria, Finland, Germany, Hungary, Netherlands, Portugal, Spain, Sweden, United Kingdom). Results show that an ideal worker culture amplifies the increase in work family conflict due to working from home, but equally for men and women. On the other hand, women are more sensitive to the proportion of colleagues working from home, and the more colleagues are working from home the less conflict they experience.
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14
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Li SA, Jeffs L, Barwick M, Stevens B. Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Syst Rev 2018; 7:72. [PMID: 29729669 PMCID: PMC5936626 DOI: 10.1186/s13643-018-0734-5] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. METHODS An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. RESULTS The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings. CONCLUSIONS We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change. These features corresponded to the constructs in the Consolidated Framework for Implementation Research (CFIR), which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices. Future research should focus on how organizational features interact to influence implementation effectiveness.
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Affiliation(s)
- Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. .,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Lianne Jeffs
- St Michael's Hospital Volunteer Association Chair in Nursing Research, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,The Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Faculties of Medicine and Dentistry, University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada
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15
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Alidina S, Goldhaber-Fiebert SN, Hannenberg AA, Hepner DL, Singer SJ, Neville BA, Sachetta JR, Lipsitz SR, Berry WR. Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers. Implement Sci 2018; 13:50. [PMID: 29580243 PMCID: PMC5870083 DOI: 10.1186/s13012-018-0739-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. Methods We conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises. Results In the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p < 0.0001) and dedicated time to train staff (p = 0.0189). Less successful implementation was associated with resistance among clinical providers to using cognitive aids (p < 0.0001), absence of an implementation champion (p = 0.0126), and unsatisfactory content or design of the cognitive aid (p = 0.0112). Conclusions Successful implementation of cognitive aids in ORs was associated with a supportive organizational context and following a multi-step implementation process. Building strong organizational support and following a well-planned multi-step implementation process will likely increase the use of OR cognitive aids during intraoperative crises, which may improve patient outcomes. Electronic supplementary material The online version of this article (10.1186/s13012-018-0739-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shehnaz Alidina
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sara N Goldhaber-Fiebert
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Alexander A Hannenberg
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara J Singer
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Bridget A Neville
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James R Sachetta
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stuart R Lipsitz
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - William R Berry
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Powell BJ, Mandell DS, Hadley TR, Rubin RM, Evans AC, Hurford MO, Beidas RS. Are general and strategic measures of organizational context and leadership associated with knowledge and attitudes toward evidence-based practices in public behavioral health settings? A cross-sectional observational study. Implement Sci 2017; 12:64. [PMID: 28499401 PMCID: PMC5429548 DOI: 10.1186/s13012-017-0593-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/04/2017] [Indexed: 11/17/2022] Open
Abstract
Background Examining the role of modifiable barriers and facilitators is a necessary step toward developing effective implementation strategies. This study examines whether both general (organizational culture, organizational climate, and transformational leadership) and strategic (implementation climate and implementation leadership) organizational-level factors predict therapist-level determinants of implementation (knowledge of and attitudes toward evidence-based practices). Methods Within the context of a system-wide effort to increase the use of evidence-based practices (EBPs) and recovery-oriented care, we conducted an observational, cross-sectional study of 19 child-serving agencies in the City of Philadelphia, including 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Organizational variables included characteristics such as EBP initiative participation, program size, and proportion of independent contractor therapists; general factors such as organizational culture and climate (Organizational Social Context Measurement System) and transformational leadership (Multifactor Leadership Questionnaire); and strategic factors such as implementation climate (Implementation Climate Scale) and implementation leadership (Implementation Leadership Scale). Therapist-level variables included demographics, attitudes toward EBPs (Evidence-Based Practice Attitudes Scale), and knowledge of EBPs (Knowledge of Evidence-Based Services Questionnaire). We used linear mixed-effects regression models to estimate the associations between the predictor (organizational characteristics, general and strategic factors) and dependent (knowledge of and attitudes toward EBPs) variables. Results Several variables were associated with therapists’ knowledge of EBPs. Clinicians in organizations with more proficient cultures or higher levels of transformational leadership (idealized influence) had greater knowledge of EBPs; conversely, clinicians in organizations with more resistant cultures, more functional organizational climates, and implementation climates characterized by higher levels of financial reward for EBPs had less knowledge of EBPs. A number of organizational factors were associated with the therapists’ attitudes toward EBPs. For example, more engaged organizational cultures, implementation climates characterized by higher levels of educational support, and more proactive implementation leadership were all associated with more positive attitudes toward EBPs. Conclusions This study provides evidence for the importance of both general and strategic organizational determinants as predictors of knowledge of and attitudes toward EBPs. The findings highlight the need for longitudinal and mixed-methods studies that examine the influence of organizational factors on implementation.
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Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599, USA.,Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Trevor R Hadley
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ronnie M Rubin
- Community Behavioral Health, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, 19107, USA.,American Psychological Association, Washington, DC, USA
| | | | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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17
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Chamberlain SA, Hoben M, Squires JE, Estabrooks CA. Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Serv Res 2016; 16:577. [PMID: 27737672 PMCID: PMC5064796 DOI: 10.1186/s12913-016-1815-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/04/2016] [Indexed: 11/27/2022] Open
Abstract
Background Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. Methods We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. Results Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack—staff, organizational slack—space, and organizational slack—time. Conclusions Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.
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Affiliation(s)
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Janet E Squires
- University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Centre for Practice-Changing Research (CPCR), 501 Smyth Road, Room 1282, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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Ramey HL, Rose-Krasnor L, Lawford HL. Youth-Adult Partnerships and Youth Identity Style. J Youth Adolesc 2017; 46:442-53. [PMID: 27037807 DOI: 10.1007/s10964-016-0474-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
Youth-adult partnerships (e.g., youth leading programs, participating as members of advisory boards) are a common and widely recommended practice in youth work and youth-serving program settings. Although researchers have suggested that these opportunities contribute to youth's identity development, empirical evidence is lacking. In the current study, we tested associations between identity style and degree of youth voice, collaborative youth-adult relationships, and youth's program engagement in 194 youth participating in youth-adult partnerships (M age = 17.6, 62 % female). We found that these characteristics of youth-adult partnerships predicted higher informational identity style, although only program engagement emerged as a unique predictor. Furthermore, exploratory analysis indicated that these associations were moderated by the type of organization. The findings suggest the need for more research on the multiple dimensions of youth-adult partnerships and their association with youth functioning, as well as pointing to the importance of the broader organizational context of youth-adult partnerships.
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Ehrhart MG, Torres EM, Wright LA, Martinez SY, Aarons GA. Validating the Implementation Climate Scale (ICS) in child welfare organizations. Child Abuse Negl 2016; 53:17-26. [PMID: 26563643 PMCID: PMC4818155 DOI: 10.1016/j.chiabu.2015.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 10/02/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
There is increasing emphasis on the use of evidence-based practices (EBPs) in child welfare settings and growing recognition of the importance of the organizational environment, and the organization's climate in particular, for how employees perceive and support EBP implementation. Recently, Ehrhart, Aarons, and Farahnak (2014) reported on the development and validation of a measure of EBP implementation climate, the Implementation Climate Scale (ICS), in a sample of mental health clinicians. The ICS consists of 18 items and measures six critical dimensions of implementation climate: focus on EBP, educational support for EBP, recognition for EBP, rewards for EBP, selection or EBP, and selection for openness. The goal of the current study is to extend this work by providing evidence for the factor structure, reliability, and validity of the ICS in a sample of child welfare service providers. Survey data were collected from 215 child welfare providers across three states, 12 organizations, and 43 teams. Confirmatory factor analysis demonstrated good fit to the six-factor model and the alpha reliabilities for the overall measure and its subscales was acceptable. In addition, there was general support for the invariance of the factor structure across the child welfare and mental health sectors. In conclusion, this study provides evidence for the factor structure, reliability, and validity of the ICS measure for use in child welfare service organizations.
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Affiliation(s)
- Mark G. Ehrhart
- Department of Psychology, San Diego State University, San Diego, CA USA
| | - Elisa M. Torres
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Lisa A. Wright
- Department of Psychology, San Diego State University, San Diego, CA USA
| | | | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
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