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The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.ORCID iD: 0000-0001-9116-8156
Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2010 (English)In: Journal of Evaluation in Clinical Practice, ISSN 1356-1294, Vol. 16, no 6, 1326-1332 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). Method The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd , 2010. Vol. 16, no 6, 1326-1332 p.
Keyword [en]
implementation, life style, organizational climate, primary health care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-65943DOI: 10.1111/j.1365-2753.2009.01336.xISI: 000285763900048OAI: oai:DiVA.org:liu-65943DiVA: diva2:400782
Note
This is the authors’ version of the following article: Siw Carlfjord, A Andersson and Per Nilsen, The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care, 2010, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, (16), 6, 1326-1332. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01336.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.htmlAvailable from: 2011-02-28 Created: 2011-02-28 Last updated: 2013-09-30
In thesis
1. The Challenge of Changing Practice: Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
Open this publication in new window or tab >>The Challenge of Changing Practice: Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased  interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.

Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.

Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.

Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 108 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1269
Keyword
Implementation; Primary Health Care; Public Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-73300 (URN)978-91-7393-039-0 (ISBN)
Public defence
2012-02-01, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-02-10 Created: 2012-01-02 Last updated: 2013-09-30Bibliographically approved

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Carlfjord, SiwNilsen, Per
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Division of Preventive and Social Medicine and Public Health ScienceFaculty of Health SciencesCentral County Primary Health CareUnit of Research and Development in Local Health Care, County of Östergötland
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