Defining and Supporting Organizational Readiness in the Interactive Systems Framework for Dissemination and Implementaion

Introduction. In the implementation literature, organizational readiness is associated with an increased likelihood of achieving innovation outcomes. Organizational readiness consists of organizational capacity (general and innovation-specific) and organization motivation. Organizations who wish to get results from their innovations have an interest in making sure that certain factors and subcomponents are in place. However, having awareness that certain capacities and factors that influence motivation are linked to improved innovation outcomes does not necessarily help organizations to get “more ready.” There is a need for organizations to know if and how they can effectively put these factors and subcomponents into place. This dissertation set out to synthesize the strength of the evidence on how the Support System can use various techniques and interventions to build organizational readiness for implementing innovations, whether support system activities that specifically target readiness factors and subcomponents as part of an innovation implementation process demonstrate better innovation outcomes than non-targeted support system activities, and whether there were any circumstances under which readiness factors and subcomponents were less responsive to support system activities. Methods. A broad based research synthesis was used to gather information about what is known about providing support to enhance organizational readiness. To identify relevant articles, the search terms for each factor or subcomponent of readiness AND implementation AND each support strategy (tools OR training OR technical assistance OR quality assurance OR quality improvement) were entered into PsycInfo and PsychArticles (Behavioral Health), Medline and CINAHL (Health Care), and Science.gov and PAIS International databases (grey literature). 4397 articles were initially identified, with the full text of 297 articles were reviewed and coded following screening. 173 articles were retained and included in the syntheses. A coding form developed for this dissertation had an interrater reliability of κ = 0.76, with a percent agreement of 89.64. Results. The information gathered in this synthesis indicated that, 1) there is evidence that support system activities can enhance certain factors and subcomponents of organizational readiness, though the strength of evidence varied between factors and subcomponents, 2) support systems activities that target readiness are more likely to see changes in readiness outcomes than those that do not (log odds =1.13; SE = 0.46; p = 0.0137; OR = 3.1; 95% CI[1.23,7.48]), 3) support system activities that target readiness are more likely to achieve innovation outcomes than those that do not (log odds = 1.92; SE = 0.84; p = 0.0234; OR = 6.8; 95% CI [1.18,38.83]), and, 4) there are some statistical differences in articles that report changes in readiness versus those that do not. Conclusion. The findings indicate that there is evidence that organization readiness can be enhanced through the use of targeted support system activities. These findings have implications for service organizations that may be mandated or otherwise pressured to implement policies, program, or process by showing that there is potential to enhance the capabilities of organizations and therefore improve their ability to get positive innovation outcomes. Some next steps for research and practice are proposed

Delivery System Capacities for Recovery-Oriented System of Care (ROSC) for Substance Abuse Disorders: An Examination of Organizational Readiness

Adopting and implementing a Recovery-Oriented System of Care (ROSC) (innovation) requires that organizations have recovery-specific systems and features (capacities) in place. Organizations, however, may requires more than specific capacities, they require the motivation to put recovery-based innovations into place. This thesis reviews the literature to examine which capacities have been identified as integral to providing recovery-oriented services within a ROSC. Surveys were distributed electronically to delivery and support staff at organizations that provide substance abuse services under the jurisdiction of the South Carolina Department of Alcohol and Drug Abuse Services. Confirmatory Factor Analysis (CFA) was used to examine how these capacities varied within and between organizations in South Carolina. Due to initial findings of an unexpected negative relationship between capacity and motivation, a secondary analysis looked how different types of motivation were related to capacity. Some implications for how these findings can be used to inform support system activities are discusse

Community Health Improvement and the Community Psychology Competencies

Community health improvement initiatives are strongly influenced by the local context in which they take place. Community coalitions of diverse stakeholders are expected to determine the needs of their population of interest, select an appropriate strategy, implement with quality, and evaluate for effectiveness. Many public health initiatives look toward behavioral scientists with experience in collaborating with community members. The competencies that community psychologists possess make them particularly useful contributors in these initiatives, especially when the projects explicitly focus on increasing health equity. This paper describes how community psychologists can contribute to community health improvement work by sharing our experiences in the Spreading Community Accelerators through Learning and Evaluation (SCALE) initiative funded by the Robert Wood Johnson Foundation. As part of SCALE, community coalitions are expected to develop appropriate aims and corresponding driver diagrams as well as implement quality improvement projects to help reach those aims. We demonstrate how community psychologists operationalize SCALE by working with communities of color in three distinct settings with different contextual factors: the Proviso Partners for Health (Chicago, IL), Boston Medical Center’s Vital Village Network (Boston, MA), and the San Gabriel Valley Healthy Cities Collaborative (Los Angeles, CA). We also describe how community psychologists contribute to the formative evaluation of the entire SCALE project. We note that specific community psychology competencies are applicable across diverse settings in community health improvement work. Consequently, community psychologists can contribute significantly to improving community health and advancing health equity

Development of a Comprehensive Measure of Organizational Readiness (Motivation × Capacity) For Implementation: A Study Protocol

BACKGROUND: Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools. The measure is informed by the Interactive Systems Framework for Dissemination and Implementation and R = MC heuristic (readiness = motivation × innovation-specific capacity × general capacity). The study aims are to adapt and further develop the readiness measure in FQHCs implementing evidence-based interventions for colorectal cancer screening, to test the validity and reliability of the developed readiness measure in FQHCs, and to adapt and assess the usability and validity of the readiness measure in schools implementing a nutrition-based program. METHODS: For aim 1, we will conduct a series of qualitative interviews to adapt the readiness measure for use in FQHCs. We will then distribute the readiness measure to a developmental sample of 100 health center sites (up to 10 staff members per site). We will use a multilevel factor analysis approach to refine the readiness measure. For aim 2, we will distribute the measure to a different sample of 100 health center sites. We will use multilevel confirmatory factor analysis models to examine the structural validity. We will also conduct tests for scale reliability, test-retest reliability, and inter-rater reliability. For aim 3, we will use a qualitative approach to adapt the measure for use in schools and conduct reliability and validity tests similar to what is described in aim 2. DISCUSSION: This study will rigorously develop a readiness measure that will be applicable across two settings: FQHCs and schools. Information gained from the readiness measure can inform planning and implementation efforts by identifying priority areas. These priority areas can inform the selection and tailoring of support strategies that can be used throughout the implementation process to further improve implementation efforts and, in turn, program effectiveness