Organizational Culture and Change

Collection of articles on Organizational Culture and Change is available here.

Organizational Characteristics and the Adoption of Electronic Health Records Among Nursing Homes in One Southern State.
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Felix H, Dayama N, Morris ME, Pradhan R, Bradway C.
Journal of applied gerontology : the official journal of the Southern Gerontological Society 2021 may;40(5):481-488.
Electronic health records (EHRs) can improve quality of care and patient safety, as demonstrated in a variety of health care settings. However, greater use of EHRs in nursing homes (NHs) is needed. To understand which NHs have and have not adopted EHR systems, all federally certified NHs in Arkansas (n = 223) were surveyed, with 27.9% responding. Non-responders were similar to responders on all characteristics except for staffing skill mix, with responders having a higher skill mix than non-responders. Two thirds of responding Arkansas NHs reported having an EHR system in use (69.8%), while only a few reported no plans for an EHR system (4.8%). NHs with greater resources and in competitive markets were more likely to implement EHR systems. Full implementation across all NHs may require intervention, which should be explored in future research. In addition, future investigation should consider the level of interoperability of EHR systems that are in place among NHs.

Organizational contextual factors that predict success of a quality improvement collaborative approach to enhance integrated HIV-tuberculosis services: a sub-study of the Scaling up TB/HIV Integration trial.
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Gengiah S, Connolly C, Yende-Zuma N, Barker PM, Nunn AJ, Padayatchi N, et al.
Implementation science : IS 2021 sep;16(1):88.
BACKGROUND: A quality improvement (QI) collaborative approach to enhancing integrated HIV-Tuberculosis (TB) services may be effective in scaling up and improving the quality of service delivery. Little is known of the role of organizational contextual factors (OCFs) in influencing the success of QI collaboratives. This study aims to determine which OCFs were associated with improvement in a QI collaborative intervention to enhance integrated HIV-TB services delivery. METHODS: This is a nested sub-study embedded in a cluster-randomized controlled trial. Sixteen nurse supervisors (clusters) overseeing 40 clinics were randomized (1:1) to receive QI training and mentorship, or standard of care support (SOC). In the QI arm, eight nurse supervisors and 20 clinics formed a “collaborative” which aimed to improve HIV-TB process indicators, namely HIV testing, TB screening, isoniazid preventive therapy (IPT) initiations, viral load testing, and antiretroviral therapy for TB patients. OCFs measured at baseline were physical infrastructure, key staff, flexibility of clinic hours, monitoring data for improvement (MDI), and leadership support. Surveys were administered to clinic staff at baseline and month 12 to assess perceptions of supportiveness of contexts for change, and clinic organization for delivering integrated HIV-TB services. Linear mixed modelling was used to test for associations between OCFs and HIV-TB process indicators. RESULTS: A total of 209 clinic staff participated in the study; 97 (46.4%) and 112 (53.6%) from QI and SOC arms, respectively. There were no differences between the QI and SOC arms scores achieved for physical infrastructure (78.9% vs 64.7%; p = 0.058), key staff (95.8 vs 92; p = 0.270), clinic hours (66.9 vs 65.5; p = 0.900), MDI (63.3 vs 65; p = 0.875, leadership support (46.0 vs 57.4; p = 0.265), and perceptions of supportiveness of contexts for change (76.2 vs 79.7; p = 0.128 and clinic organization for delivering integrated HIV-TB services (74.1 vs 80.1; p = 0.916). IPT initiation was the only indicator that was significantly improved in the parent study. MDI was a significantly associated with increasing IPT initiation rates [beta coefficient (β) = 0.004; p = 0.004]. DISCUSSION: MDI is a practice that should be fostered in public health facilities to increase the likelihood of success of future QI collaboratives to improve HIV-TB service delivery. TRIAL REGISTRATION: , NCT02654613 . Registered 01 June 2015.

Quick and dirty or rapid and informative? Exploring a participatory method to facilitate implementation research and organizational change.
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von Thiele Schwarz Ulrica, Andersson K, Loeb C.
Journal of health organization and management 2021 sep
PURPOSE: The purpose is explore an approach to acquire, analyze and report data concerning an organizational change initiative that combines knowledge generation and knowledge use, and contrast that with a method where knowledge generation and use is separated. More specifically, the authors contrast a participatory group workshop with individual interviews analyzed with thematic analysis, focusing on information about the change process and its perceived practical relevance and usefulness. DESIGN/METHODOLOGY/APPROACH: Participants were managers responsible for implementing a broad organizational change aiming to improve service quality (e.g. access and equity) and reduce costs in a mental health service organization in Sweden. Individual interviews were conducted at two points, six months apart (i1: n = 15; i2: n = 18). Between the interviews, a 3.5-h participatory group workshop was conducted, during which participants (n = 15) both generated and analyzed data through a structured process that mixed individual-, small- and whole-group activities. FINDINGS: Both approaches elicited substantive information about the content, purpose and process of change. While the content and purpose findings were similar across the two data sources, the interviews described how to lead a change process, whereas the workshop yielded concrete information about what to do. Benefits of interviews included personal insights about leading change while the workshop provided an opportunity for collective sense-making. ORIGINALITY/VALUE: When organizational stakeholders work through the change process through a participatory workshop, they may get on the same page, but require additional support to take action.