School of Social Work, Boise State University, Boise, Idaho, United States of America.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2018 Dec 21;13(12):e0209745. doi: 10.1371/journal.pone.0209745. eCollection 2018.
Clinician turnover is a major concern as mental health systems and organizations invest substantial resources in the implementation of evidence-based practice (EBP). In this study, we identify malleable factors associated with reduced clinician turnover during a system-wide EBP implementation initiative. Specifically, we examine how proficient organizational culture (i.e., norms and behavioral expectations that clinicians prioritize improvement in client well-being and exhibit competence in up-to-date treatment practices), EBP implementation climate (i.e., perceptions that the organization's policies, procedures, and practices support EBP use), and change in these organizational characteristics relate to clinician turnover during a system-wide EBP transformation.
Data were collected from 236 clinicians in 19 mental health clinics across 3 years of a system-wide EBP implementation initiative in the City of Philadelphia. Clinicians reported on proficient organizational culture and EBP implementation climate at baseline (T1) and two-year follow-up (T2). Administrators reported on clinician turnover at three-year follow-up (T3). Hypotheses were tested via multilevel mediation analyses incorporating mixed effects logistic regression models.
Controlling for organization size, clinician job satisfaction, attitudes towards EBP, job tenure, and age, higher levels of proficient organizational culture and improvement in proficient culture from baseline to two-year follow-up predicted reduced clinician turnover in the year following; these effects were mediated by EBP implementation climate and by improvement in EBP implementation climate, respectively.
Organizations with more proficient cultures have more supportive EBP implementation climates that predict reduced clinician turnover during system-wide EBP implementation initiatives. Strategies that target these antecedents in mental health service organizations may contribute to reduced clinician turnover.
由于心理健康系统和组织在实施基于证据的实践 (EBP) 方面投入了大量资源，因此临床医生的更替是一个主要关注点。在这项研究中，我们确定了与系统范围内实施 EBP 倡议期间减少临床医生更替相关的可塑因素。具体来说，我们研究了熟练的组织文化（即，临床医生优先提高客户福祉并表现出最新治疗实践能力的规范和行为期望）、EBP 实施氛围（即，组织的政策、程序和实践支持 EBP 使用的看法），以及这些组织特征在系统范围内 EBP 转型期间如何与临床医生更替相关。
数据来自费城系统范围内实施 EBP 倡议的 3 年中 19 家心理健康诊所的 236 名临床医生。临床医生在基线 (T1) 和两年随访 (T2) 时报告了熟练的组织文化和 EBP 实施氛围。管理员在三年随访 (T3) 时报告了临床医生的更替情况。通过混合效应逻辑回归模型纳入多层次中介分析检验了假设。
在控制组织规模、临床医生工作满意度、对 EBP 的态度、工作任期和年龄后，较高水平的熟练组织文化以及从基线到两年随访的熟练文化改善，预测了一年后临床医生更替减少；这些效应分别由 EBP 实施氛围和 EBP 实施氛围的改善所介导。
具有更熟练文化的组织具有更具支持性的 EBP 实施氛围，可预测在系统范围内实施 EBP 倡议期间临床医生更替减少。针对心理健康服务组织中这些前因的策略可能有助于减少临床医生的更替。
