Influencers of Staff Perceptions of Organizational Sustainability Capacity in a Quality Improvement Collaborative James H. Ford II, PhD Aaron M. Gilson MS, MSSW, PhD 11 th Annual Dissemination and Implementation Conference, December 3-5, 2018
Acknowledgements • This project was supported through funding provided by the National Institute of Drug Abuse R21 DA36700 (PI: Ford), R01 DA037222 (PI: Ford and McGovern), and R01 DA020832 (PI: Gustafson) • Staff of the 201 addiction treatment providers in the states of Massachusetts, Michigan, New York, Oregon, and Washington. The content is responsibility of the authors and does not necessarily represent • the official views of NIH. • Dr. Ford is the principle of JHFordII Healthcare Consulting LLC which provides organizational coaching to behavioral healthcare providers • All other authors have no conflicts of interest
Constructs of Organizational vs. Intervention Sustainability Organizational Constructs Intervention Constructs Belief in the initiative Demonstrating effectiveness Community participation Funding Defining aims and shared vision Integrate w/existing programs & policies Demonstrating effectiveness Intervention adaption and receptivity Leadership and champions Leadership and champions Monitoring programs over time Monitoring programs over time Organizational Readiness & Capacity Organizational values & culture Organizational values & culture Resources general Resources general Stakeholder participation Stakeholder participation Training and capacity building Lennox, L., Maher, L., & Reed, J. (2018). Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implementation Science, 13(1), 27.
Research Question What staff characteristics predict levels of sustainability capacity across the study timeframe?
NIATx 200 Quality Improvement Collaborative • Recruited 201 substance abuse treatment providers in five states (MA, MI, NY, OR and WA). • Assigned providers to one of four interventions (Interest Circles, Learning Sessions, Coaching, or a Combination of all three). • Primary outcomes: wait time, retention and new admissions. • Secondary outcomes: staff readiness for change and staff perceptions about sustainability propensity. 1. Gustafson, D. H., Quanbeck, A. R., Robinson, J. M., Ford II, J. H., Pulvermacher, A., French, M. T., ... McCarty, D. (2013). Which elements of improvement collaboratives are most effective? A cluster‐randomized trial. Addiction, 2013; 108(6):1145 -57. PMCID: PMC3651751. doi: 10.1111/add.12117 2. Quanbeck, A. R., Gustafson, D. H., Ford II, J. H., Pulvermacher, A., French, M. T., McConnell, K. J., & McCarty, D. (2011). Disseminating quality improvement: study protocol for a large cluster randomized trial. Implementation Science, 6:44. PMCID: PMC3108336. doi: 10.1186/1748-5908-6-44
NIATx 200 Intervention Periods Participation measured over active intervention period 9 Months Baseline Staff Survey (T1) 9 Months Staff Survey (T2) 9 Months Staff Survey (T3) Staff Survey (T4)
BNHS Sustainability Index 7
Constructs of Organizational vs. Intervention Sustainability Organizational Constructs Intervention Constructs Belief in the initiative Demonstrating effectiveness Community participation Funding Defining aims and shared vision Integrate w/existing programs & policies Demonstrating effectiveness Intervention adaption and receptivity Leadership and champions Leadership and champions Monitoring programs over time Monitoring programs over time Organizational Readiness & Capacity Organizational values & culture Organizational values & culture Resources general Resources general Stakeholder participation Stakeholder participation Training and capacity building Lennox, L., Maher, L., & Reed, J. (2018). Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implementation Science, 13(1), 27.
BNHS Sustainability Index 9
Outcome Measure British National Health Service Sustainability Index Mean (SE) Time 1 71.914 (1.031) Time 2 75.559 (0.992) Time 3 78.428 (0.965) Time 4 78.657 (1.094) Cases were matched based on unique identifiers • Organizational ID, Job Function, First Name Initial, Day of Birth, Staff Employment Status Analysis • Bivariate analyses were run on outcome measure and each anticipated study variable before entry into models Tenure at Organization was excluded because of non-significance Statistical models derived from Linear Mixed Model Repeated Measures Analysis •
Statistical Models • Time Model #1 4 periods during the NIATx200 intervention
Statistical Models • Time 4 periods during the NIATx200 intervention • NIATx200 implementation strategy Model #2 learning sessions, interest circles, coaching, or combinations • Job Function administrative vs. clinical
Statistical Models • Time 4 periods during the NIATx200 intervention • NIATx200 implementation strategy learning sessions, interest circles, coaching, or combinations Model #3 • Job Function administrative vs. clinical • Extent of participation in NIATx200 implementation strategies low vs. high
Results: Model #1 Variable Estimate Std. Err. df t Sign. Lower Upper 95% CI 95% CI Time 4,1 6.74 1.50 947 4.49 p=.0001 3.79 9.69 Time 4,2 3.10 1.48 955 2.10 p=.036 0.20 5.99 Time 4,3 0.23 1.46 945 0.16 p>.05 -2.63 3.09 Conclusions • Staff perceptions of sustainability increased throughout most of the study timeframe
Results: Model #2 Variable Estimate Std. df t Sign. Lower Upper Err. 95% CI 95% CI Time 4,1 7.17 1.55 867 4.62 p=.0001 4.12 10.22 Time 4,2 3.00 1.53 877 1.96 p=.05 0.01 6.00 Time 4,3 0.12 1.51 890 0.08 p>.05 -2.85 3.08 Comb vs. learning 3.28 1.47 1842 2.23 p=.026 0.39 6.17 Comb vs. circles 2.15 1.53 1848 1.41 p>.05 -0.85 5.14 Comb vs. coaching 0.21 1.44 1850 0.15 p>.05 -2.62 3.04 Job Function (clinical) 3.50 1.07 1850 3.27 p=.001 1.40 5.59 Conclusions • Staff perceptions of sustainability increased throughout most of the study timeframe • Combined NIATx200 strategies were associated with higher sustainability, compared to learning sessions alone • Organization administrators had higher sustainability scores
Results: Model #3 Variable Estimate Std. df t Sign. Lower Upper Err. 95% CI 95% CI Time 4,1 7.11 1.55 868 4.58 p=.0001 4.06 10.16 Time 4,2 3.01 1.53 879 1.97 p=.05 0.01 6.01 Time 4,3 0.07 1.51 887 0.05 p>.05 -2.89 3.03 Comb vs. learning 3.40 1.47 1840 2.31 p=.021 0.51 6.29 Comb vs. circles 1.73 1.54 1850 1.12 p>.05 -1.30 4.75 Comb vs. coaching 0.15 1.45 1850 0.10 p>.05 -2.99 2.70 Job Function (clinical) 3.42 1.07 1850 3.21 p=.001 1.33 5.52 Extent participation (low) 2.21 1.09 1849 2.02 p=.043 0.07 4.35 Conclusions • Staff perceptions of sustainability increased throughout most of the study timeframe • Combined NIATx200 strategies were associated with higher sustainability, compared to learning sessions alone • Organization administrators had higher sustainability scores • Greater participation in implementation strategies led to higher perceptions of sustainability
Limitations • Limited staff demographic information – Related to employment only • Case variation across time phases • 27-month intervention timeframe – Some variation in 9-month periods • Does not represent staff-level participation in QIC activities – Clinic-level, but still depends on staff involvement
Implications for D&I Research • Likely saturation effect for perceptions of improved sustainability – Need to continue building importance of sustainability within organizations • Staff differences in perception that change will sustain within organizations – Need to engage clinicians to convince them that change can be sustained • Exposure promotes belief in sustainability – Supported both through combinations of implementation strategies and extent of participation
Thank you Contact: Jay Ford (jhfordii@wisc.edu) @JHFordII| #DIscience18
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