School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83725, USA.
Department of Psychology, University of Central Florida, Orlando, FL, USA.
Implement Sci. 2018 Jun 25;13(1):85. doi: 10.1186/s13012-018-0781-2.
Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians' shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians' shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians' implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate's concurrent and long-term relationships with clinicians' use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate.
Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians' evidence-based practice use at baseline and at 2-year follow-up.
In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians' use of evidence-based practice at either time point.
Optimizing clinicians' implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.
行为健康组织的特点是存在多种组织氛围，包括整体氛围，它包含临床医生对工作环境如何影响个人幸福感的共同看法，以及战略实施氛围，它包括临床医生对组织期望、支持和奖励实施基于证据的实践的程度的共同看法。理论表明，这些氛围对临床医生实施基于证据的实践有共同的、跨层次的影响，并且这些影响可能是长期的（即长达 2 年）；然而，没有实证研究检验过这些关系。我们假设，整体氛围调节实施氛围与临床医生使用基于证据的实践的同时期和长期关系，即当战略实施氛围伴随着积极的整体氛围时，它将产生最积极的影响。
使用从 20 个行为健康组织的 235 名临床医生收集的数据检验假设。在基线时，临床医生报告了整体氛围和实施氛围。在基线和 2 年随访时，所有在组织中出现的临床医生都报告了他们使用认知行为心理治疗技术的情况，这是一种针对青年精神疾病的基于证据的实践。两级混合效应回归模型检验了基线整体氛围和实施氛围是否在预测临床医生在基线和 2 年随访时使用基于证据的实践方面存在交互作用。
在基线时整体氛围更积极的组织中，更高水平的实施氛围预测了在基线时出现的临床医生和在 2 年随访时出现的临床医生使用基于证据的实践的增加；然而，在整体氛围不那么积极的组织中，实施氛围与临床医生在任何时间点使用基于证据的实践都没有关系。
要优化行为健康中临床医生对基于证据的实践的实施，需要关注整体氛围和战略实施氛围。如果组织不能营造积极的整体氛围，那么只关注实施氛围的策略可能不是改变行为的有效手段。这些发现对实施理论和有效实施策略的发展具有重要意义。
