Organizational factors and depression management in community-based primary care settings

Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.http://deepblue.lib.umich.edu/bitstream/2027.42/78269/1/1748-5908-4-84.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/2/1748-5908-4-84-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/3/1748-5908-4-84.pdfPeer Reviewe

Project management turnover: causes and effects on project performance

Changes in management personnel - variously termed displacement, succession or just turnover- have been found by many to have significant negative effects on project performance. However, researchers have often ignored the organizational context of succession, the timing of succession relative to the organizational life cycle, and the type of transfer undertaken in control surfaces. It has also been suggested that the idea of specifically choosing a project manager to see the project completely through its life cycle needs to be discarded in favour of selecting at each phase point, a new project manager best suited to the anticipated project environment. To examine this further, a web-based survey was designed and developed from a detailed literature review, with 67 completed surveys collected, equating to a 45% response rate. This aimed to: find the reasons for project management turnover; examine the extent to which project management turnover is associated with a particular phase of the project life cycle; and investigate the effects of project management turnover on project performance. The most significant findings are that project management turnover occurs predominantly in the execution phase of the project life cycle and that the main reasons for the turnover event are career motives, including the need for personal development, and dissatisfaction with the organisational culture and project management role. The results confirm that the turnover event disrupts and negatively affects the performance of the project team, the project, and potentially negates the competitive advantage of organisations in which it occurs