Will a Good Citizen Actively Support Organizational Change? Investigation of Psychological Processes Underlying Active Change Support

The present study investigated motivational factors of employees active change support (ACS). It also investigated good citizens response to the change by highlighting convergence and divergence of motivational factors between ACS and traditional extra-role behavior. The findings based on 166 staff responses and 346 supervisor assessments in a hospital that recently implemented a sharedgovernance structure suggest that active change support is a result of an active thinking process that involves perception of potential benefit from change but not necessarily the consequence of conventional predictors of extra-role behaviors (i.e., positive attitudes). The findings also suggest that good citizens are not necessarily the supporters of organizational change and that in actuality they confront motivational dilemma especially when they hold high quality relationship with their employer because they are reluctant to challenge the status quo

Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma: A Mixed-Methods Study.

BackgroundThe overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma.ObjectiveThis article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country.MethodsWe evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework.ResultsReach -: The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy-There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption -: The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation- The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance -: Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion.ConclusionData from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool.Trial registrationNCT01453621, Registered September 27, 2011