Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity.
Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity.
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DOI：
10.1007/s10488-016-0742-5
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发表时间：
2017-03
影响因子：
2.6
通讯作者：
Green, Philip
中科院分区：
文献类型：
--
作者：
Williams, Nathaniel J.;Glisson, Charles;Hemmelgarn, Anthony;Green, Philip
关键词：
由于对提高临床医生循证实践（EBP）采用的变革机制了解不足，心理健康领域高效且可扩展的实施策略的制定受到限制。本研究测试了跨级别变革机制，该机制将支持实施的经验支持的组织策略（标记为可用性、响应性和连续性的 ARC）与心理健康临床医生的 EBP 采用和使用联系起来。 14 个儿童心理健康机构的 475 名心理健康临床医生被随机分配到 ARC 干预组或对照组。在为期三年的 ARC 干预之前、期间和完成后收集了组织文化、临床医生采用 EBP 的意图以及与工作相关的 EBP 障碍的测量结果。 EBP 的采用和使用在 12 个月的随访中进行评估。多层次中介分析测试了组织文化的变化、临床医生采用 EBP 的意图以及与工作相关的 EBP 障碍，作为解释 ARC 对临床医生采用和使用 EBP 的影响的联系机制。在 12 个月的随访中，ARC 提高了临床医生对 EBP 的采用率（OR = 3.19，p = .003）和使用率（81% vs. 56%，d = .79，p = .003）。这些影响是通过组织能力文化的改善来调节的，从而提高了临床医生采用 EBP 的意愿，并减少了与工作相关的 EBP 障碍。联合中介分析表明，组织文化-EBP意图机制是ARC影响临床医生EBP采用和使用的主要载体。 ARC 通过创建熟练的组织文化来提高临床医生采用 EBP 的意愿，从而提高临床医生对 EBP 的采用和使用。
The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians’ evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians’ EBP adoption and use. Four hundred seventy five mental health clinicians in 14 children’s mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians’ EBP adoption and use. ARC increased clinicians’ EBP adoption (OR = 3.19, p = .003) and use (81% vs. 56%, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC’s effects on clinicians’ EBP adoption and use. ARC increases clinicians’ EBP adoption and use by creating proficient organizational cultures that increase clinicians’ intentions to adopt EBPs.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
7.2
作者：
Aarons, Gregory A.;Glisson, Charles;Landsverk, John A.
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DOI：
10.1016/j.jaac.2013.02.005
发表时间：
2013-05-01
影响因子：
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作者：
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通讯作者：
Williams, Nathaniel J.
影响因子：
9.9
作者：
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Kinicki, Angelo
影响因子：
3.9
作者：
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Dunn, Chris