Influencers of Staff Perceptions of Organizational Sustainability - - PowerPoint PPT Presentation

Influencers of Staff Perceptions of Organizational Sustainability Capacity in a Quality Improvement Collaborative

James H. Ford II, PhD Aaron M. Gilson MS, MSSW, PhD 11th Annual Dissemination and Implementation Conference, December 3-5, 2018

Acknowledgements

• This project was supported through funding provided by the National Institute
• f 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
• rganizational 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

• f 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

Baseline Staff Survey (T1) Staff Survey (T2) Staff Survey (T3) Staff Survey (T4)

9 Months 9 Months 9 Months

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

• Organizational ID, Job Function, First Name Initial, Day of Birth, Staff Employment Status

Time1 Time2 Time3 Time4 Mean (SE) 71.914 (1.031) 75.559 (0.992) 78.428 (0.965) 78.657 (1.094)

Cases were matched based on unique identifiers

• 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

Analysis

Statistical Models

• Time
• 4 periods during the NIATx200 intervention

Model #1

Statistical Models

• Time
• 4 periods during the NIATx200 intervention

Model #2

• NIATx200 implementation strategy
• learning sessions, interest circles,

coaching, or combinations

• Job Function
• administrative vs. clinical

Statistical Models

• Time
• 4 periods during the NIATx200 intervention

Model #3

• NIATx200 implementation strategy
• learning sessions, interest circles,

coaching, or combinations

• 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 95% CI Upper 95% CI Time4,1 6.74 1.50 947 4.49 p=.0001 3.79 9.69 Time4,2 3.10 1.48 955 2.10 p=.036 0.20 5.99 Time4,3 0.23 1.46 945 0.16 p>.05

• 2.63

3.09

• Staff perceptions of sustainability increased throughout most of the study timeframe

Conclusions

Results: Model #2

Variable Estimate Std. Err. df t Sign. Lower 95% CI Upper 95% CI Time4,1 7.17 1.55 867 4.62 p=.0001 4.12 10.22 Time4,2 3.00 1.53 877 1.96 p=.05 0.01 6.00 Time4,3 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

• 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

Conclusions

Results: Model #3

Variable Estimate Std. Err. df t Sign. Lower 95% CI Upper 95% CI Time4,1 7.11 1.55 868 4.58 p=.0001 4.06 10.16 Time4,2 3.01 1.53 879 1.97 p=.05 0.01 6.01 Time4,3 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

• 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

Conclusions

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