| Title |
Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies
|
|---|---|
| Published in |
Implementation Science, July 2018
|
| DOI | 10.1186/s13012-018-0787-9 |
| Pubmed ID | |
| Authors |
Shawna N. Smith, Daniel Almirall, Katherine Prenovost, David E. Goodrich, Kristen M. Abraham, Celeste Liebrecht, Amy M. Kilbourne |
| Abstract |
Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. ISRCTN: ISRCTN21059161 . Date registered: April 11, 2013. |
X Demographics
The data shown below were collected from the profiles of 9 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 5 | 56% |
| Unknown | 4 | 44% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 67% |
| Scientists | 2 | 22% |
| Science communicators (journalists, bloggers, editors) | 1 | 11% |
Mendeley readers
The data shown below were compiled from readership statistics for 97 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 97 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 16 | 16% |
| Researcher | 11 | 11% |
| Student > Doctoral Student | 11 | 11% |
| Student > Ph. D. Student | 8 | 8% |
| Other | 7 | 7% |
| Other | 15 | 15% |
| Unknown | 29 | 30% |
| Readers by discipline | Count | As % |
|---|---|---|
| Psychology | 17 | 18% |
| Nursing and Health Professions | 15 | 15% |
| Medicine and Dentistry | 8 | 8% |
| Business, Management and Accounting | 7 | 7% |
| Social Sciences | 6 | 6% |
| Other | 10 | 10% |
| Unknown | 34 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 August 2018.
All research outputs
#7,004,897
of 25,311,095 outputs
Outputs from Implementation Science
#1,117
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Outputs of similar age
#110,413
of 333,231 outputs
Outputs of similar age from Implementation Science
#38
of 46 outputs
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