Implementation of evidence-based practices: Applying a goal commitment framework

Ann F. Chou, Thomas E. Vaughn, Kimberly D. McCoy, Bradley Doebbeling

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: The implementation of evidence-based practices translates research findings into practice to reduce inappropriate care. However, this process is slow and unpredictable. The lack of a coherent theoretical basis for understanding individual and organizational behavior limits our ability to formulate effective implementation strategies. Purpose: The study objectives are (a) to test the goal commitment framework that explains mechanisms impacting outcomes of major depressive disorder (MDD) screening guideline implementation and (b) to understand the effects of implementation outcomes on provider practice related to MDD screening. Methods: Using data from the Determinants of Clinical Practice Guideline Implementation Effectiveness Study, the national sample included 2,438 clinicians from 139 Veteran Affairs acute care hospitals with primary care clinics. We used hierarchical generalized linear modeling to assess the following implementation outcomes: agreement with, adherence to, improvement in knowledge of guidelines, and delivery of best practices as a function of clinician input into implementation, teamwork, involvement in quality improvement activities, participative culture, interdepartmental coordination, frequency, and utility of performance feedback. We then estimated self-reported MDD screening practices as a function of these four implementation outcomes. Findings: Results showed that having input into implementation, involvement in quality of care improvement, teamwork, and perceived value of performance feedback were positively associated with implementation outcomes. Provider self-assessed guideline adherence was positively associated with the likelihood of appropriate MDD screening. Implications: Factors related to increased goal commitment positively predicted key implementation outcomes, which in turn enhanced care delivery. This study demonstrates that the goal commitment framework is useful in assisting managers to assess factors that facilitate implementation. In particular, participation, feedback, and team work equip organizational participants with better information about implementation targets, thereby increasing adherence. Instituting or improving systems or programs to facilitate timely, appropriate performance feedback and provider participation may help enhancing organizational change and learning.

Original languageEnglish (US)
Pages (from-to)4-17
Number of pages14
JournalHealth Care Management Review
Volume36
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Evidence-Based Practice
Major Depressive Disorder
Quality Improvement
Practice Guidelines
Guidelines
Guideline Adherence
Organizational Innovation
Aptitude
Quality of Health Care
Veterans
Primary Health Care
Learning
Evidence-based practice
Goal commitment
Research

Keywords

  • Clinical practice guidelines
  • depression
  • evidence-based practice
  • implementation
  • quality of care

ASJC Scopus subject areas

  • Strategy and Management
  • Health Policy
  • Leadership and Management

Cite this

Implementation of evidence-based practices : Applying a goal commitment framework. / Chou, Ann F.; Vaughn, Thomas E.; McCoy, Kimberly D.; Doebbeling, Bradley.

In: Health Care Management Review, Vol. 36, No. 1, 01.2011, p. 4-17.

Research output: Contribution to journalArticle

Chou, Ann F. ; Vaughn, Thomas E. ; McCoy, Kimberly D. ; Doebbeling, Bradley. / Implementation of evidence-based practices : Applying a goal commitment framework. In: Health Care Management Review. 2011 ; Vol. 36, No. 1. pp. 4-17.
@article{eb8438981b5b451ba037d23dd6d621d6,
title = "Implementation of evidence-based practices: Applying a goal commitment framework",
abstract = "Background: The implementation of evidence-based practices translates research findings into practice to reduce inappropriate care. However, this process is slow and unpredictable. The lack of a coherent theoretical basis for understanding individual and organizational behavior limits our ability to formulate effective implementation strategies. Purpose: The study objectives are (a) to test the goal commitment framework that explains mechanisms impacting outcomes of major depressive disorder (MDD) screening guideline implementation and (b) to understand the effects of implementation outcomes on provider practice related to MDD screening. Methods: Using data from the Determinants of Clinical Practice Guideline Implementation Effectiveness Study, the national sample included 2,438 clinicians from 139 Veteran Affairs acute care hospitals with primary care clinics. We used hierarchical generalized linear modeling to assess the following implementation outcomes: agreement with, adherence to, improvement in knowledge of guidelines, and delivery of best practices as a function of clinician input into implementation, teamwork, involvement in quality improvement activities, participative culture, interdepartmental coordination, frequency, and utility of performance feedback. We then estimated self-reported MDD screening practices as a function of these four implementation outcomes. Findings: Results showed that having input into implementation, involvement in quality of care improvement, teamwork, and perceived value of performance feedback were positively associated with implementation outcomes. Provider self-assessed guideline adherence was positively associated with the likelihood of appropriate MDD screening. Implications: Factors related to increased goal commitment positively predicted key implementation outcomes, which in turn enhanced care delivery. This study demonstrates that the goal commitment framework is useful in assisting managers to assess factors that facilitate implementation. In particular, participation, feedback, and team work equip organizational participants with better information about implementation targets, thereby increasing adherence. Instituting or improving systems or programs to facilitate timely, appropriate performance feedback and provider participation may help enhancing organizational change and learning.",
keywords = "Clinical practice guidelines, depression, evidence-based practice, implementation, quality of care",
author = "Chou, {Ann F.} and Vaughn, {Thomas E.} and McCoy, {Kimberly D.} and Bradley Doebbeling",
year = "2011",
month = "1",
doi = "10.1097/HMR.0b013e3181dc8233",
language = "English (US)",
volume = "36",
pages = "4--17",
journal = "Health Care Management Review",
issn = "0361-6274",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Implementation of evidence-based practices

T2 - Applying a goal commitment framework

AU - Chou, Ann F.

AU - Vaughn, Thomas E.

AU - McCoy, Kimberly D.

AU - Doebbeling, Bradley

PY - 2011/1

Y1 - 2011/1

N2 - Background: The implementation of evidence-based practices translates research findings into practice to reduce inappropriate care. However, this process is slow and unpredictable. The lack of a coherent theoretical basis for understanding individual and organizational behavior limits our ability to formulate effective implementation strategies. Purpose: The study objectives are (a) to test the goal commitment framework that explains mechanisms impacting outcomes of major depressive disorder (MDD) screening guideline implementation and (b) to understand the effects of implementation outcomes on provider practice related to MDD screening. Methods: Using data from the Determinants of Clinical Practice Guideline Implementation Effectiveness Study, the national sample included 2,438 clinicians from 139 Veteran Affairs acute care hospitals with primary care clinics. We used hierarchical generalized linear modeling to assess the following implementation outcomes: agreement with, adherence to, improvement in knowledge of guidelines, and delivery of best practices as a function of clinician input into implementation, teamwork, involvement in quality improvement activities, participative culture, interdepartmental coordination, frequency, and utility of performance feedback. We then estimated self-reported MDD screening practices as a function of these four implementation outcomes. Findings: Results showed that having input into implementation, involvement in quality of care improvement, teamwork, and perceived value of performance feedback were positively associated with implementation outcomes. Provider self-assessed guideline adherence was positively associated with the likelihood of appropriate MDD screening. Implications: Factors related to increased goal commitment positively predicted key implementation outcomes, which in turn enhanced care delivery. This study demonstrates that the goal commitment framework is useful in assisting managers to assess factors that facilitate implementation. In particular, participation, feedback, and team work equip organizational participants with better information about implementation targets, thereby increasing adherence. Instituting or improving systems or programs to facilitate timely, appropriate performance feedback and provider participation may help enhancing organizational change and learning.

AB - Background: The implementation of evidence-based practices translates research findings into practice to reduce inappropriate care. However, this process is slow and unpredictable. The lack of a coherent theoretical basis for understanding individual and organizational behavior limits our ability to formulate effective implementation strategies. Purpose: The study objectives are (a) to test the goal commitment framework that explains mechanisms impacting outcomes of major depressive disorder (MDD) screening guideline implementation and (b) to understand the effects of implementation outcomes on provider practice related to MDD screening. Methods: Using data from the Determinants of Clinical Practice Guideline Implementation Effectiveness Study, the national sample included 2,438 clinicians from 139 Veteran Affairs acute care hospitals with primary care clinics. We used hierarchical generalized linear modeling to assess the following implementation outcomes: agreement with, adherence to, improvement in knowledge of guidelines, and delivery of best practices as a function of clinician input into implementation, teamwork, involvement in quality improvement activities, participative culture, interdepartmental coordination, frequency, and utility of performance feedback. We then estimated self-reported MDD screening practices as a function of these four implementation outcomes. Findings: Results showed that having input into implementation, involvement in quality of care improvement, teamwork, and perceived value of performance feedback were positively associated with implementation outcomes. Provider self-assessed guideline adherence was positively associated with the likelihood of appropriate MDD screening. Implications: Factors related to increased goal commitment positively predicted key implementation outcomes, which in turn enhanced care delivery. This study demonstrates that the goal commitment framework is useful in assisting managers to assess factors that facilitate implementation. In particular, participation, feedback, and team work equip organizational participants with better information about implementation targets, thereby increasing adherence. Instituting or improving systems or programs to facilitate timely, appropriate performance feedback and provider participation may help enhancing organizational change and learning.

KW - Clinical practice guidelines

KW - depression

KW - evidence-based practice

KW - implementation

KW - quality of care

UR - http://www.scopus.com/inward/record.url?scp=78650861411&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650861411&partnerID=8YFLogxK

U2 - 10.1097/HMR.0b013e3181dc8233

DO - 10.1097/HMR.0b013e3181dc8233

M3 - Article

C2 - 21157225

AN - SCOPUS:78650861411

VL - 36

SP - 4

EP - 17

JO - Health Care Management Review

JF - Health Care Management Review

SN - 0361-6274

IS - 1

ER -