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Organizational readiness in specialty mental health care.

Hamilton AB, Cohen AN, Young AS - J Gen Intern Med (2010)

Bottom Line: Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort.Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention.We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.

View Article: PubMed Central - PubMed

Affiliation: VA Desert Pacific Mental Illness Research, Education and Clinical Center, and UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, USA. alisonh@ucla.edu

ABSTRACT

Background: Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia.

Objective: To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies.

Design: EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline.

Participants: At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed.

Main results: The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters.

Conclusions: Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.

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ORC program needs subscale.
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Fig2: ORC program needs subscale.

Mentions: As depicted in Table 1, scores were consistent, with few high standard deviations. The staff attributes domain seemed to be the area of greatest strength across sites, with staff reporting high levels of agreement with regard to staff growth and adaptability. The program needs subscale (see Fig. 2) had the most inconsistency, with SDs of 9 or more in three of the four sites.Figure 2


Organizational readiness in specialty mental health care.

Hamilton AB, Cohen AN, Young AS - J Gen Intern Med (2010)

ORC program needs subscale.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2806963&req=5

Fig2: ORC program needs subscale.
Mentions: As depicted in Table 1, scores were consistent, with few high standard deviations. The staff attributes domain seemed to be the area of greatest strength across sites, with staff reporting high levels of agreement with regard to staff growth and adaptability. The program needs subscale (see Fig. 2) had the most inconsistency, with SDs of 9 or more in three of the four sites.Figure 2

Bottom Line: Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort.Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention.We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.

View Article: PubMed Central - PubMed

Affiliation: VA Desert Pacific Mental Illness Research, Education and Clinical Center, and UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, USA. alisonh@ucla.edu

ABSTRACT

Background: Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia.

Objective: To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies.

Design: EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline.

Participants: At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed.

Main results: The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters.

Conclusions: Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.

Show MeSH
Related in: MedlinePlus