Organizational Readiness in Specialty Mental Health Care
Organizational Readiness in Specialty Mental Health Care
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DOI：
10.1007/s11606-009-1133-3
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发表时间：
2010-01-01
影响因子：
5.7
通讯作者：
Young, Alexander S.
中科院分区：
文献类型：
--
作者：
Hamilton, Alison B.;Cohen, Amy N.;Young, Alexander S.
在诊所实施质量改进工作具有挑战性。评估组织对变革的“准备程度”，可以提供关于现有优势和不足的信息，从而为实施工作奠定基础，从而增加改进工作取得成功的机会。本文讨论了专业心理健康的组织评估，在准备改善个人的精神分裂症的护理，以评估专业心理健康变化的组织准备，以促进当地量身定制的实施strategies.EQUIP-2是一个网站级的控制试验在9个VA医疗中心（4干预，5控制）。所有研究中心的提供者完成了组织变革准备（ORC）测量，干预研究中心的主要利益相关者在基线时完成了半结构化访谈。在四个干预研究中心，16名管理人员和43名临床工作人员完成了ORC，38名主要利益相关者接受了访谈。培训需求、沟通和变革的准备领域是平均得分较低的领域（即，潜在缺陷），在10-50分的量表上，从低的23.8分到高的36.2分不等，而工作人员的成长和适应性属性的平均得分较高（即，潜在强度）范围从35.4的最低值到41.1的最高值。半结构化访谈显示，工作人员的看法和经验的变化和决策的影响较大的结构性因素，如从VA headquarters.Motivation的变化，组织气候，工作人员的看法和信念，以及以前的经验与变化的努力有助于专业心理健康的变化准备。对变化准备不足的站点在实施质量改进干预时可能需要更大的灵活性。我们建议，可以通过调整实施工作的优势和不足的组织，正在实施质量改进的变化，以加强吸收基于证据的做法。
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.To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies.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.At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed.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.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.