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Mouchaers I, Buma LE, Verbeek H, Zwakhalen S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care. Sci Rep 2024; 14:11391. [PMID: 38762551 PMCID: PMC11102453 DOI: 10.1038/s41598-024-62047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
| | - Lise E Buma
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Cicero Zorggroep, Brunssum, The Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Sandra Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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Boyd MR, Becker KD, Park AL, Pham K, Chorpita BF. Managers' Micro-Communities Matter: The Impact of Clinical Supervision Team on Therapist Perception of the Organization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01376-0. [PMID: 38676872 DOI: 10.1007/s10488-024-01376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.
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Affiliation(s)
- Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Kaitlyn Pham
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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Stefánsdóttir NT, Nilsen P, Lindstroem MB, Andersen O, Powell BJ, Tjørnhøj-Thomsen T, Kirk JW. Implementing a new emergency department: a qualitative study of health professionals' change responses and perceptions. BMC Health Serv Res 2022; 22:447. [PMID: 35382815 PMCID: PMC8985264 DOI: 10.1186/s12913-022-07805-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study is two-fold. It explores how managers and key employees at the Emergency Department (ED) and specialist departments in a university hospital in the Capital Region of Denmark respond to the planned change to a new ED, and how they perceive the change involved in the implementation of the new ED. The study investigates what happens when health professionals are confronted with implementation of policy that changes their organization and everyday work lives. Few studies provide in-depth investigations of health professionals’ reactions to the implementation of new EDs, and particularly how they influence the implementation of a nationwide organizational change framed within a political strategy. Methods The study used semi-structured individual interviews with 51 health professionals involved in implementation activities related to an organizational change of establishing a new ED with new patient pathways for acutely ill patients. The data was deductively analyzed using Leon Coetsee’s theoretical framework of change responses, but the analysis also allowed for a more inductive reading of the material. Results Fourteen types of responses to establishing a new ED were identified and mapped onto six of the seven overall change responses in Coetsee’s framework. The participants perceived the change as particularly three changes. Firstly, they wished to create the best possible acute patient pathway in relation to their specialty. Whether the planned new ED would redeem this was disputed. Secondly, participants perceived the change as relocation to a new building, which both posed potentials and worries. Thirdly, both hopeful and frustrated statements were given about the newly established medical specialty of emergency medicine (EM), which was connected to the success of the new ED. Conclusions The study showcases how implementation processes within health care are not straightforward and that it is not only the content of the implementation that determines the success of the implementation and its outcomes but also how these are perceived by managers and employees responsible for the process and their context. In this way, managers must recognize that it cannot be pre-determined how implementation will proceed, which necessitates fluid implementation plans and demands implementation managements skills.
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Affiliation(s)
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen K, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, 8000, Aarhus C, Denmark
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Kassab H, Scott K, Boyd MR, Puspitasari A, Endicott D, Lewis CC. Tailored isn't always better: Impact of standardized versus tailored training on intention to use measurement-based care. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221087477. [PMID: 37091104 PMCID: PMC9924248 DOI: 10.1177/26334895221087477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Brief educational trainings are often used for disseminating and implementing evidence-based practices (EBPs). However, many accessible trainings are ubiquitously standardized. Tailored training focused on modifying individual or contextual factors that may hinder EBP implementation is recommended, but there is a dearth of research comparing standardized versus tailored training. This study sought to: (a) assess the impact of MBC training on clinician intention to use measurement-based care (MBC); (b) compare the effect of standardized versus tailored training on clinician intention to MBC; and (c) identify clinician-level predictors of intention. Methods: Clinicians (n = 152) treating adult clients with depression at 12 community mental health clinics were randomized to either tailored or standardized MBC training. Clinic-specific barriers and facilitators were used to inform training content and structure tailoring. Linear mixed modeling tested the association between training condition and post-training intention to use MBC, as well as hypothesized individual-level predictors of post-training intention (e.g., age, gender). Results: Clinician intention pre- and post-training increased across training conditions (B = 0.38, t = -5.95, df = 36.99, p < .01, Cohen's d = 0.58). Results of linear mixed modeling procedures suggest no significant difference in clinician intention between conditions post-training (B = -0.03, SE = .19, p > .05, Cohen's d = .15). Only baseline intention emerged as a predictor of post-training intention (B = 0.39, SE = .05, p < .05). Conclusions: These findings suggest the additional effort to tailor training may not yield incremental benefit over standardized training, at least in the short term. As a result, implementation efforts may be able to reserve time and finances for other elements of implementation beyond the training component. Plain Language Summary Educational training is a common approach for enhancing knowledge about research-supported mental health treatments. However, these trainings are often not tailored to meet the needs of the trainees, and there is insufficient evidence about whether tailoring might improve the impact of training compared to a one-size-fits-all, standard version. This study compared the impact of a tailored versus standard training on mental health clinician's intentions to use measurement-based (MBC) care for monitoring treatment progress for clients with depression. Study results indicated that intention to use MBC improved for clinicians receiving both the tailored and standard training after training completion. There were no differences in intention to use MBC care when the two types of training were compared. These study findings suggest that tailoring, which may require substantial time and effort, may not be a necessary step to improve the short-term impact of educational trainings.
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Affiliation(s)
| | - Kelli Scott
- Brown University School of Public Health, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Cara C. Lewis
- Kaiser Permanente Washington Health Research
Institute, Seattle, WA, USA
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