Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis

Nathaniel J Williams; Emily M Becker-Haimes; Simone H Schriger; Rinad S Beidas

doi:10.1186/s43058-022-00309-y

Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis

Implement Sci Commun. 2022 Jun 11;3(1):64. doi: 10.1186/s43058-022-00309-y.

Authors

Nathaniel J Williams¹, Emily M Becker-Haimes^{2

3}, Simone H Schriger⁴, Rinad S Beidas^{2

5

6

7

8

9}

Affiliations

¹ School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83625, USA. natewilliams@boisestate.edu.
² Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
³ Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA.
⁴ Department of Psychology, University of Pennsylvania, Philadelphia, USA.
⁵ Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
⁶ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
⁷ Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
⁸ Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, USA.
⁹ Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.

Abstract

Background: Theory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implementation outcomes and cross-sectional designs. This study combines data from two studies spanning 7 years to test the hypothesis that higher levels of organizational EBP implementation climate prospectively predicts improved clinician adherence to an EBP, cognitive behavioral therapy (CBT), as rated by expert observers.

Methods: Biennial assessments of EBP implementation climate collected in 10 community mental health agencies in Philadelphia as part of a systemwide evaluation (time 1) were linked to subsequent observer ratings of clinician adherence to CBT in clinical encounters with 108 youth (time 2). Experts rated clinician adherence to CBT using the Therapy Process Observation Coding System which generated two primary outcomes (a) maximum CBT adherence per session (i.e., highest rated CBT intervention per session; depth of delivery) and (b) average CBT adherence per session (i.e., mean rating across all CBT interventions used; depth and breadth of delivery).

Results: On average, time 2 clinician adherence observations occurred 19.8 months (SD = 10.15) after time 1 organizational climate assessments. Adjusting for organization, clinician, and client covariates, a one standard deviation increase in organizational EBP implementation climate at time 1 predicted a 0.63-point increase in clinicians' maximum CBT adherence per session at time 2 (p = 0.000), representing a large effect size (d = 0.93; 95% CI = 0.63-1.24) when comparing organizations in the upper (k = 3) versus lower tertiles (k = 3) of EBP implementation climate. Higher levels of time 1 organizational EBP implementation climate also predicted higher time 2 average CBT adherence per session (b = 0.23, p < 0.001, d = 0.72). Length of time between assessments of climate and adherence did not moderate these relationships.

Conclusions: Organizational EBP implementation climate is a promising predictor of clinicians' subsequent observed adherence to CBT. Implementation strategies that target this antecedent may improve the delivery of EBPs in healthcare settings.

Keywords: Adherence; Cognitive behavioral therapy; Evidence-based practice; Implementation climate.

Abstract

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