Understanding organizational culture and implementation of evidence-based resuscitation practices

了解组织文化和实施循证复苏实践

• 批准号: 10591266
• 负责人: Elizabeth Foglia
• 金额: $ 8.9万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-20 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10591266
• 关键词: Academy; Address; Admission activity; Adoption; American; Attention; Baseline Surveys; Behavioral; Belief; Birth; Caring; Cessation of life; Characteristics; Clinical; Closure by clamp; Collaborations; Communication; Communication Barriers; Cross-Sectional Studies; Data; Delivery Rooms; Development; Discipline; Dissemination and Implementation; Education; Educational Curriculum; Elements; Environment; Event; Evidence based practice; Factor Analysis; Funding; Future; Goals; Guideline Adherence; Guidelines; Hospitals; Infant; Infant Care; Infrastructure; Intervention; Measures; Modeling; National Institute of Child Health and Human Development; Neonatal Intensive Care Units; Newborn Infant; Organizational Culture; Outcome; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Pediatrics; Penetration; Perception; Philadelphia; Physiologic Thermoregulation; Premature Infant; Process; Promoting Action on Research Implementation in Health Services framework; Property; Psyche structure; Psychometrics; Quality of Care; Recommendation; Reporting; Research; Resuscitation; Role; Safety; Surveys; Testing; Time; United States National Institutes of Health; Validation; Variant; Work; disability; evidence base; evidence based guidelines; follow-up; health care settings; implementation context; implementation outcomes; improved; instrument; member; neonatal resuscitation; patient population; pilot test; prevent; programs; psychologic; respiratory; response; secondary analysis; secondary outcome; skills; sound; success; support network; surfactant; ventilation

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.

项目摘要 大约10%的新生儿出生后需要产房（DR）复苏，以防止死亡或 残疾。存在循证新生儿复苏指南，但循证实践（EBP）和 准则的使用并不一致。因此，在DR中，EBP存在重要的实施差距 复苏导致护理质量低下。 成功的复苏和EBP实施需要三个因素：证据（例如，准则）， 促进（例如，教育努力），和背景（例如，环境/组织）。美国 儿科学院新生儿复苏计划通过生成证据提供了其中两个因素- 根据指导方针和传播教育课程。然而，很少有人注意到 第三个因素：当地环境。组织文化（组织中的信念、观念和价值观）是一种 这是当地环境的基本组成部分，并直接影响关键的复苏行为技能。 然而，组织文化在实施DR复苏EBP中的作用仍然存在 替补演员这是一个潜在的机会，以改善实施环境，为产房 护理，最终改善DR复苏过程和结果。 我们的目标是调整和验证组织文化和试点复苏的具体措施 测试其与DR EBP实施结果的关联。一个关键的差距是，没有复苏的具体 组织文化的措施存在。该提案将1）调整并验证复苏专用 组织文化的测量; 2）检查组织文化和EBP之间的关联 实施，评估DR EBP渗透率（定义为DR环境中实践的集成） 和工作人员报告的结果（例如，实施的成功），进一步验证了 组织文化复苏的具体措施。这项横向研究将整合一个网络- 对14家医院进行了广泛调查，该医院开展了一项积极的、网络支持的DR质量改进项目，重点关注 为早产儿推广DR EBP。 验证复苏特定的组织文化衡量标准是理解的关键一步 组织文化在产房复苏中的作用。审查组织结构的组成部分 文化和协会与EBP实施有可能告知未来的努力，以改善 在所有类型的婴儿出生的医院进行复苏。这项工作还具有超越 DR，因为我们的适应性措施不特定于DR复苏，可以应用于其他 患者人群和医疗机构。