Powell Byron J, Mandell David S, Hadley Trevor R, Rubin Ronnie M, Evans Arthur C, Hurford Matthew O, Beidas Rinad S
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.
Implement Sci. 2017 May 12;12(1):64. doi: 10.1186/s13012-017-0593-9.
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).
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.
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.
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.
研究可改变的障碍因素和促进因素的作用是制定有效实施策略的必要步骤。本研究考察一般层面（组织文化、组织氛围和变革型领导）和战略层面（实施氛围和实施领导）的组织因素是否能够预测治疗师层面的实施决定因素（对循证实践的了解和态度）。
在全系统努力增加循证实践（EBPs）使用和以康复为导向的护理的背景下，我们对费城的19个儿童服务机构进行了一项观察性横断面研究，包括23个场所、130名治疗师、36名督导和22名行政管理人员。组织变量包括参与循证实践倡议、项目规模以及独立承包商治疗师的比例等特征；一般因素如组织文化和氛围（组织社会环境测量系统）以及变革型领导（多因素领导问卷）；战略因素如实施氛围（实施氛围量表）和实施领导（实施领导量表）。治疗师层面的变量包括人口统计学特征、对循证实践的态度（循证实践态度量表）以及对循证实践的了解（循证服务知识问卷）。我们使用线性混合效应回归模型来估计预测变量（组织特征、一般因素和战略因素）与因变量（对循证实践的了解和态度）之间的关联。
几个变量与治疗师对循证实践的了解相关。在文化更精通或变革型领导水平更高（理想化影响力）的组织中的临床医生对循证实践的了解更多；相反，在文化更抵触、组织氛围更注重功能以及实施氛围以对循证实践给予更高经济奖励为特征的组织中的临床医生对循证实践的了解较少。一些组织因素与治疗师对循证实践的态度相关。例如，参与度更高的组织文化、以更高教育支持水平为特征的实施氛围以及更积极主动的实施领导都与对循证实践更积极的态度相关。
本研究为一般层面和战略层面的组织决定因素作为循证实践知识和态度的预测指标的重要性提供了证据。研究结果凸显了开展纵向和混合方法研究以考察组织因素对实施的影响的必要性。
