National Meeting 2007

1016 — Identifying Organizational Characteristics in Facilitating the Implementation of Evidence-Based Practices in VAMCs

Chou AF (University of Oklahoma) , Jones LE (Indianapolis VA- COE), McCoy K (Indianapolis VA- COE), Sutherland JM (Indianapolis VA- COE), Safford M (Birmingham VA ), Doebbeling BN (Indianapolis VA- COE)

Implementation of evidence-based practices (EBPs) is associated with improved clinical and cost outcomes. Previous studies have identified a number of discrete organizational characteristics important in implementation although a general framework that identifies components of effective implementation is lacking. This study specifies a conceptual framework by identifying organizational factors that may facilitate implementation.

A national sample of 242 quality managers from 129 VA facilities was surveyed. Managers who participated responded to questions assessing experience with EBPs, culture, processes related to EBP implementation, and facility characteristics. We conducted an exploratory factor analysis including items from a large subset of the managers survey to determine the optimal number of factors. To maximize the variance of loadings and interpretability, orthogonal varimax rotation was performed. Alpha values were calculated for each factor scale derived from the factor analysis.

Factor analysis yielded a six-factor solution, illustrating distinct domains for the conceptual framework of implementation: (1) Cooperative and flexible culture (Cronbach a=0.89), where team work and interdepartmental coordination is encouraged; (2) Structured implementation process (a=0.90), where key implementation steps are planned, executed, and monitored; (3) VISN/leadership support (a=0.87), where the VISN provides support and fosters competition among facilities; (4) Resources (a=0.85), where personnel and financial resources are dedicated to implementation; (5) Staff Resistance (a=0.64); where sources of resistance were identified; and (6) Measurement (a=0.67), where data are collected to measure and evaluate performance.

Our conceptual model of EBP implementation includes six factor scales that facilitate implementation of quality improvement (QI). A commitment by leadership (e.g., the VISN) provides legitimacy and a catalyst for change. Sufficient resources, acceptance and ownership by providers, a culture that encourages flexibility and participation, and a structured process of implementing and monitoring change may lead to buy-in from the staff, which may in turn increase compliance to EBPs.

Successful implementation of EBPs has important implications for care coordination and management of patients’ overall health. The framework from our study can be used in empiric research to assess how and whether organizational contextual factors (culture, VISN support, and resistance) and process factors (structured implementation process, resources, and measurement) may enhance implementation efforts and measurement.