The impact of organisational change and fiscal restraint on organisational culture

International Experience of Implementing Cognitive Remediation for People With Psychotic Disorders

BACKGROUND

Cognitive remediation (CR) is an effective therapy for the cognitive impact of mental illness, especially schizophrenia. Global efforts are being made to implement CR into routine mental health services with the aim of improving functional outcomes for the population of people recovering from mental illness. Implementation and dissemination of CR in heterogeneous settings require knowledge gleaned from formal implementation research and pragmatic experiential learning. This article describes cross-cultural approaches to CR implementation, focusing on initiatives in France, the United States, Australia, and Japan.

METHOD

Key leaders in the implementation of CR in France, the United States, Australia, and Japan were asked to describe the implementation and dissemination process in their settings with respect to the categories of context, implementation, outcomes, facilitators, and barriers.

RESULTS

All 4 sites noted the role of collaboration to leverage the implementation of CR into mental health rehabilitation services. In France, high-level, government organizational backing enhanced the dissemination of CR. Academic and clinical service partnerships in the United States facilitated the dissemination of programs. The advocacy from service users, families, and carers can aid implementation. The support from international experts in the field can assist in initiating programs but maintenance and dissemination require ongoing training and supervision of staff.

CONCLUSIONS

CR is an effective intervention for the cognitive impact of schizophrenia. Programs can be implemented in diverse settings globally. Adaptations of CR centering upon the core components of effective CR therapy enhance outcomes and enable programs to integrate into diverse settings.

Complexity Leadership: Constructing 21st-Century Health Care

In this 21st-century postdigital age, deeper and more relevant understandings of both structure and process are critical in laying the foundations for the success of human enterprises and systems for the foreseeable future. Leadership of these complex, networked initiatives and environments will require a fundamentally different understanding and tool sets essential to the well-designed, linked, and integrated undertaking of the human enterprise. This is no less true of the unfolding health care networks now becoming the substantive framework for the delivery of health care services in the foreseeable future. This article explicates the essentials of this new model for leadership.