Preparing for Implementation: Finding Good Fit Between Practice Innovation and Organizational Context
Successful implementation of treatment innovations depends on agreement among clinicians’ that a new practice fits with organizational values, practices, and beliefs (Proctor et al, 2011; Klein & Sorra, 1996). Clinicians’ perceptions about fit may depend on their knowledge of the innovation being implemented, and the organization. Evidence suggests that clinicians’ receive different training, exposure, and experience with evidence based practices depending on a variety of disciplinary and experiential factors (Weissman, et al 2006) which may influence their beliefs about the fit of a new practice within the organizational context. However, whether and how these factors influence fit has not yet been investigated. Understanding why perceived fit varies among clinicians could inform strategies for promoting successful implementation. Therefore, this study addresses the question, what clinician and organizational factors are associated with perceived fit of a treatment innovation (trauma-focused cognitive behavioral therapy, TF-CBT) with organizational values and practice?
Surveys were administered in person to 149 clinicians from 25 children’s behavioral health organizations on the first day of a year-long regional TF-CBT training. Perceived fit was measured with a newly developed eight-item scale based on Klein and Sorra’s (1996) definition of innovation-values fit. Participants’ experience in the field, job role, professional discipline, prior knowledge of TF-CBT, relationships with local TF-CBT experts, and communication among implementation team members were collected. Organizational size was measured as the number of employees. We conducted a mixed effect multi-level model to address our research aims.
Agreement among implementation team members and perceived fit varied considerably accounting for 55% of the variance, while agreement between implementation teams was marginal and accounted for only 38% of the variance (ICC = .32). Therefore, the study demonstrated high variation between perceived fit among individual clinicians and some variation between agencies. At the individual level, perceived fit was positively associated with ties to experts (β=0.196, SE=0.088, p<.05) and prior training in the intervention (β=1.294, SE=0.466, p<.01). Also, psychologists had a negative association with perceived fit to the innovation (β=-0.400, SE=0.181; p<.05) and social worker’s positive association was marginally significant. Neither job role nor communication with team member predicted fit was significantly associated with perceived fit. However, organizational size positively predicted fit.
Findings suggest that perceived fit between a practice innovation and organizational setting varies within agency teams. Clinicians perceived better fit when they had prior knowledge about TF-CBT, social ties to local TF-CBT experts, and had social work training. On the other hand, psychologists perceived poorer fit of TF-CBT. These findings expand on prior research by suggesting that disciplinary differences in training, and ties to innovation experts impact implementation (Brekke et al, 2009), by influencing clinicians’ perceptions about fit. Information dissemination and networking with practice champions prior to adoption may improve perceived fit and contribute toward successful implementation.