Understanding organizational culture and implementation of evidence-based resuscitation practices

项目总结 大约10%的新生儿在出生后需要进行产房(DR)复苏，以防止死亡或 残疾。循证新生儿复苏指南是存在的，但循证实践(EBPS)和 指导方针的使用并不一致。因此，灾难恢复中的EBPS存在一个重要的实施差距 导致低质量护理的复苏。 成功的复苏和EBP实施需要三个因素：证据(例如，指南)， 促进(如教育努力)和背景(如当地环境/组织)。《美国人》 儿科学会新生儿复苏计划通过产生证据提供了其中两个因素- 以指导方针为基础，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，组织文化在实施复苏方案中的作用仍然存在 未得到充分研究。这是改善产房实施环境的潜在机会 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特定于复苏的组织文化和试点措施 测试其与DR EBP实施结果的关联。一个关键的差距是没有专门针对复苏的 组织文化是有衡量标准的。该提案将1)修改和验证特定于复苏的 测量组织文化；以及2)检查组织文化和企业行为之间的关联 实施，评估DR EBP渗透率(定义为DR环境中实践的整合) 和工作人员报告的结果(例如，感觉到的实施成功)，提供了对 复苏--组织文化的具体衡量标准。这项横断面研究将整合一个网络- 对14家医院进行了广泛调查，其中包括一个积极的、网络支持的灾难恢复质量改进项目，重点是 为早产儿推广DR EBPS。 验证特定于复苏的组织文化措施是理解以下问题的关键一步 组织文化在产房复苏中的作用。检查组织的组成部分 与EBP实施有关的文化和联系有可能为今后改进的努力提供信息 在婴儿出生的所有类型的医院进行复苏。这项工作的影响也超出了 DR，因为我们的适应措施不是特定于DR复苏的，并且可以应用于其他 患者群体和医疗保健设置。

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.