Incorporators, Early Investors, and Learners: a longitudinal study of organizational adaptation during EBP implementation and sustainment
Incorporators, Early Investors, and Learners: a longitudinal study of organizational adaptation during EBP implementation and sustainment
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DOI：
10.1186/s13012-020-01031-w
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发表时间：
2020-09-10
影响因子：
7.2
通讯作者：
Aarons, Gregory A.
中科院分区：
文献类型：
--
作者：
Lengnick-Hall, Rebecca;Willging, Cathleen E.;Aarons, Gregory A.
大多数关于循证实践（EBP）适应的文献都集中在临床实践的变化上，而没有明确说明组织必须如何适应新的EBP。本研究探讨的过程中，组织，而不是EBP的适应实施和维持。据作者所知，以前没有以这种方式关注组织适应的实施研究。方法本分析采用个案研究的方法，检查纵向定性数据从17个社区为基础的组织（CBO）在一个国家和7个县为基础的儿童福利系统。社区组织持续了2至10年的忽视儿童干预EBP（SafeCare（R））。分析的单位是组织，每个CBO代表一个案例。创建了企业级配置文件，以描述组织的适应过程。结果组织层面的适应性特征包括：创业者（n= 7）、早期投资者（n= 6）和学习者（n= 4）。通过将SafeCare整合到现有运营中来适应的解决方案，以满足合同或EBP的保真度要求。早期投资者在早期实施期间进行了大量的组织调整，然后随着EBP嵌入组织和服务系统而相对一致地运作。学习者的特点是稳定且持续地关注组织可以适应以支持EBP的新方式。结论EBP的维持有多种有效途径。调整组织适应性以适应CBO的运营（例如，程序的大小）和直接的环境约束（例如，资金水平）。此外，各组织在参与EBP实施的实体网络中发挥不同的职能作用。了解组织角色和适应概况可以指导实施规划，并有助于构建连接外部（系统）和内部（组织）环境的合同设计。适应概况还可以说明执行战略调整进程的强度以及向各组织推销战略的方式。
Background The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. This study explores the process of organizational-rather than EBP-adaptation during implementation and sustainment. To the authors' knowledge, there are no previous implementation studies that focus on organizational adaptation in this way. Methods This analysis utilizes a case study approach to examine longitudinal qualitative data from 17 community-based organizations (CBOs) in one state and seven county-based child welfare systems. The CBOs had sustained a child-neglect intervention EBP (SafeCare (R)) for 2 to 10 years. The unit of analysis was the organization, and each CBO represented a case. Organizational-level profiles were created to describe the organizational adaptation process. Results Three organizational-level adaptation profiles were identified as follows: incorporators (n= 7), early investors (n= 6), and learners (n= 4). Incorporators adapted by integrating SafeCare into existing operations to meet contractual or EBP fidelity requirements. Early Investors made substantial organizational adaptations during the early implementation period, then operated relatively consistently as the EBP became embedded in the organization and service system. Learners were characterized by steady and continuous attention to new ways that the organization could adapt to support the EBP. Conclusion The profiles demonstrated that there can be multiple effective paths to EBP sustainment. Organizational adaptation was calibrated to fit a CBO's operations (e.g., size of the program) and immediate environmental constraints (e.g., funding levels). Additionally, organizations fulfilled different functional roles in the network of entities involved in EBP implementation. Knowing organizational roles and adaptation profiles can guide implementation planning and help to structure contract designs that bridge the outer (system) and inner (organizational) contexts. Adaptation profiles can also inform the intensity of the implementation strategy tailoring process and the way that strategies are marketed to organizations.