Organizational Factors Associated with Implementation of Evidence-Based Practices

Purpose               Dissemination of evidence-based practices (EBPs) to routine treatment settings is of major concern to researchers and practitioners alike. Models of implementation in human service systems have acknowledged the importance of systemic factors, including the organizational context.¹Organizational culture (shared norms and expectations) and organizational climate (psychological impact of the workplace on staff) can influence the degree to which new treatment models are implemented as designed.  This study assessed the relationship between organizational culture and climate and fidelity to the multiple family group model of psychoeducation (MFG) using data collected during a statewide implementation in New York.

Methods              Baseline training in the MFG model was followed by monthly consultation with outside experts in MFG over 18 months. 238 staff from 29 participating organizations were surveyed on measures of organizational culture (leadership and attitudes towards families) and organizational climate (job satisfaction and emotional exhaustion).  Fidelity outcomes were captured using the Family Psychoeducation Fidelity Scale and records of milestone achievement.  Predictor variables were assessed using r_WGprior to aggregation at the organization level. Spearman’s rho and independent-sample t-tests were used to test hypotheses that positive organizational culture and organizational climate are associated with greater fidelity. Logistic regression was then used to examine whether emotional exhaustion predicted fidelity.

Results                  Few agencies succeeded in achieving high fidelity to the MFG model, and clinical items had lower fidelity scores compared to structural items. Higher levels of emotional exhaustion predicted lower fidelity on structural components of MFG after controlling for agency size: for every unit increase in emotional exhaustion, odds of being classified with lower fidelity on structural components increased by 7.325 (95%CI: 0.718, 74.707).  Attitude towards families was associated with specific items on the Fidelity Scale but not with overall fidelity. Other relationships were generally in the hypothesized direction. Effect sizes were modest. 

Implications       Study findings are aligned with earlier research showing that implementation outcomes are associated with organizational culture and climate.  Organizations with a culture positively oriented towards families achieved higher fidelity on certain elements of the MFG model, underscoring the importance of innovation-organization fit.  Organizations with a climate of greater emotional exhaustion scored lower on structural elements, suggesting that staff may have less energy to engage with families as prescribed by MFG model.  Agencies implementing EBPs should consider interventions that demonstrate alignment of the EBP with its mission and vision and mitigate emotional exhaustion.  Implementation models used in national demonstration projects, such as the use of expert consultant-trainers, may not be sufficient to achieve high-fidelity outcomes in routine settings. States looking to implement EBPs should consider targeting technical assistance and support to components of the model identified by agencies as particularly challenging.

 1. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: A synthesis of the literature.Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network;2005.