Can EBP Utilization and Good Organizational Culture and Climates Co-Exist?

Background/ Purpose: After some initial debate it seems that the utilization of scientifically supported treatments, often referred to as evidence-based practices (EBPs), is considered the gold standard of patient care. While there are many studies investigating best practices and how to adopt them, what is largely missing are studies particularly investigating the working conditions in programs that are currently uses EBPs. This study compared a large organization’s culture and climate scores of programs that use EBPs and those indicating no EBP usage. A study was conducted with a large organization that offers many types of social work services, with some using EBPs. The overall purpose of this evaluation was to compare the organizational culture and climate scores of programs that use EBPs and do not use EBPs.  

Methods: The study was carried with the largest child and family human service agency in Western and Central New York State.  Participants in this study worked in a total of 55 different program types with 27 using EBPs. All participants in this study were 'front-line' employees with a total sample of 1,273. The Organizational Social Context Measurement Model survey was used to measure culture and climate (Glisson, 2002). The three factors making up an organization’s culture are: Proficiency (.94): placing the health and well-being of patients first with high proficiency; Rigidity (.81): workers have a small amount of discretion and flexibility; and Resistance (.81) workers showing little interests in changes or new ways of providing services. The factors making up organizational climate consists of: Engagement (.78): worker’s perceptions that they can accomplish worthwhile activities and stay personally involved in their work; Functionality (.90): receiving support from their coworkers with a well-defined understanding of how they fit into the organization; and Stress (.94): workers are emotionally exhausted and overwhelmed.

Results: Programs using EBPs had a significant more rigid and resistant culture compared to programs not using any EBPs. Also, programs using EBPs indicated its working climate was significantly less engaged and functional, as well as significantly more stressed, compared to those not using any EBPs.

Conclusions and Implications: Although literature cautioned that some worker’s experiences might be disrupted and cause organizational disturbances, the outcome from this study might encourage us to reinvestigate some of those earlier concerns. It could be reasonable to expect that the organization would become more rigid when it has decided to commit to a specific, program-wide EBP. Also, in order to retain some level of fidelity to the EBP, the organization may be rigid and resistant to any other clinical changes for a while. Organizations that have developed a regular custom around the use of existing practices lose their self-reinforcing system for worker stability when new practices enter the system. Trying to alter the work-group’s past routines with new ones might provide a cause of overall resistance, rigidities, feeling less functional and engaged along with feeling stressed out. While these outcomes are concerning for programs using or thinking about using EBPs, as with any new study, more investigation is needed.