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Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis

BACKGROUND: Theory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implem...

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Autores principales: Williams, Nathaniel J., Becker-Haimes, Emily M., Schriger, Simone H., Beidas, Rinad S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188232/
https://www.ncbi.nlm.nih.gov/pubmed/35690845
http://dx.doi.org/10.1186/s43058-022-00309-y
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author Williams, Nathaniel J.
Becker-Haimes, Emily M.
Schriger, Simone H.
Beidas, Rinad S.
author_facet Williams, Nathaniel J.
Becker-Haimes, Emily M.
Schriger, Simone H.
Beidas, Rinad S.
author_sort Williams, Nathaniel J.
collection PubMed
description BACKGROUND: Theory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implementation outcomes and cross-sectional designs. This study combines data from two studies spanning 7 years to test the hypothesis that higher levels of organizational EBP implementation climate prospectively predicts improved clinician adherence to an EBP, cognitive behavioral therapy (CBT), as rated by expert observers. METHODS: Biennial assessments of EBP implementation climate collected in 10 community mental health agencies in Philadelphia as part of a systemwide evaluation (time 1) were linked to subsequent observer ratings of clinician adherence to CBT in clinical encounters with 108 youth (time 2). Experts rated clinician adherence to CBT using the Therapy Process Observation Coding System which generated two primary outcomes (a) maximum CBT adherence per session (i.e., highest rated CBT intervention per session; depth of delivery) and (b) average CBT adherence per session (i.e., mean rating across all CBT interventions used; depth and breadth of delivery). RESULTS: On average, time 2 clinician adherence observations occurred 19.8 months (SD = 10.15) after time 1 organizational climate assessments. Adjusting for organization, clinician, and client covariates, a one standard deviation increase in organizational EBP implementation climate at time 1 predicted a 0.63-point increase in clinicians’ maximum CBT adherence per session at time 2 (p = 0.000), representing a large effect size (d = 0.93; 95% CI = 0.63–1.24) when comparing organizations in the upper (k = 3) versus lower tertiles (k = 3) of EBP implementation climate. Higher levels of time 1 organizational EBP implementation climate also predicted higher time 2 average CBT adherence per session (b = 0.23, p < 0.001, d = 0.72). Length of time between assessments of climate and adherence did not moderate these relationships. CONCLUSIONS: Organizational EBP implementation climate is a promising predictor of clinicians’ subsequent observed adherence to CBT. Implementation strategies that target this antecedent may improve the delivery of EBPs in healthcare settings.
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spelling pubmed-91882322022-06-12 Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis Williams, Nathaniel J. Becker-Haimes, Emily M. Schriger, Simone H. Beidas, Rinad S. Implement Sci Commun Research BACKGROUND: Theory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implementation outcomes and cross-sectional designs. This study combines data from two studies spanning 7 years to test the hypothesis that higher levels of organizational EBP implementation climate prospectively predicts improved clinician adherence to an EBP, cognitive behavioral therapy (CBT), as rated by expert observers. METHODS: Biennial assessments of EBP implementation climate collected in 10 community mental health agencies in Philadelphia as part of a systemwide evaluation (time 1) were linked to subsequent observer ratings of clinician adherence to CBT in clinical encounters with 108 youth (time 2). Experts rated clinician adherence to CBT using the Therapy Process Observation Coding System which generated two primary outcomes (a) maximum CBT adherence per session (i.e., highest rated CBT intervention per session; depth of delivery) and (b) average CBT adherence per session (i.e., mean rating across all CBT interventions used; depth and breadth of delivery). RESULTS: On average, time 2 clinician adherence observations occurred 19.8 months (SD = 10.15) after time 1 organizational climate assessments. Adjusting for organization, clinician, and client covariates, a one standard deviation increase in organizational EBP implementation climate at time 1 predicted a 0.63-point increase in clinicians’ maximum CBT adherence per session at time 2 (p = 0.000), representing a large effect size (d = 0.93; 95% CI = 0.63–1.24) when comparing organizations in the upper (k = 3) versus lower tertiles (k = 3) of EBP implementation climate. Higher levels of time 1 organizational EBP implementation climate also predicted higher time 2 average CBT adherence per session (b = 0.23, p < 0.001, d = 0.72). Length of time between assessments of climate and adherence did not moderate these relationships. CONCLUSIONS: Organizational EBP implementation climate is a promising predictor of clinicians’ subsequent observed adherence to CBT. Implementation strategies that target this antecedent may improve the delivery of EBPs in healthcare settings. BioMed Central 2022-06-11 /pmc/articles/PMC9188232/ /pubmed/35690845 http://dx.doi.org/10.1186/s43058-022-00309-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Williams, Nathaniel J.
Becker-Haimes, Emily M.
Schriger, Simone H.
Beidas, Rinad S.
Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title_full Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title_fullStr Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title_full_unstemmed Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title_short Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
title_sort linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188232/
https://www.ncbi.nlm.nih.gov/pubmed/35690845
http://dx.doi.org/10.1186/s43058-022-00309-y
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