Understanding organizational culture and implementation of evidence-based resuscitation practices

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PROJECT SUMMARY Approximately 10% of all newborns require delivery room (DR) resuscitation after birth to prevent death or disability. Evidence-based neonatal resuscitation guidelines exist, but evidence-based practices (EBPs) and guidelines are not used consistently. Thus, there is an important implementation gap for EBPs in DR resuscitation that contributes to low quality care. Successful resuscitation and EBP implementation requires three factors: evidence (e.g., guidelines), facilitation (e.g., educational efforts), and context (e.g., the local environment/organization). The American Academy of Pediatrics Neonatal Resuscitation Program provides two of these factors by generating evidence- based guidelines and disseminating an educational curriculum. However, little attention has been paid to the third factor: local context. Organizational culture (the beliefs, perceptions, and values in an organization) is a fundamental component of the local context and directly influences key resuscitation behavioral skills. However, the role of organizational culture in the implementation of DR resuscitation EBPs remains understudied. This represents a potential opportunity to improve the implementation context for delivery room care, ultimately improving DR resuscitation processes and outcomes. Our objective is to adapt and validate a resuscitation-specific measure of organizational culture and pilot test its association with DR EBP implementation outcomes. A critical gap is that no resuscitation-specific measure of organizational culture exists. This proposal will 1) adapt and validate a resuscitation-specific measure of organizational culture; and 2) examine associations between organizational culture and EBP implementation, assessing both DR EBP penetration (defined as integration of a practice within the DR setting) and staff-reported outcomes (e.g., perceived implementation success), providing further validation of the resuscitation-specific measure of organizational culture. This cross-sectional study will integrate a network- wide survey of 14 hospitals with an active, network-supported DR quality improvement project focused on promoting DR EBPs for preterm infants. Validation of a resuscitation-specific measure of organizational culture is a critical step in understanding the role of organizational culture in delivery room resuscitation. Examining components of organizational culture and associations with EBP implementation has the potential to inform future efforts to improve resuscitation across all types of hospitals where infants are born. This work also has implications beyond the DR, as our adapted measure is not specific to DR resuscitation and could be applied to resuscitations in other patient populations and healthcare settings.