Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study

Abstract Background Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians’ shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes cli...

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Main Authors: Nathaniel J. Williams, Mark G. Ehrhart, Gregory A. Aarons, Steven C. Marcus, Rinad S. Beidas
Format: Article
Language:English
Published: BMC 2018-06-01
Series:Implementation Science
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13012-018-0781-2
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spelling doaj-8f6d514d800841ee859827812d8f7d302020-11-25T00:45:15ZengBMCImplementation Science1748-59082018-06-0113111310.1186/s13012-018-0781-2Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational studyNathaniel J. Williams0Mark G. Ehrhart1Gregory A. Aarons2Steven C. Marcus3Rinad S. Beidas4School of Social Work, Boise State UniversityDepartment of Psychology, University of Central FloridaDepartment of Psychiatry, University of CaliforniaSchool of Social Policy and Practice, University of PennsylvaniaDepartment of Psychiatry, University of PennsylvaniaAbstract Background Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians’ shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians’ shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians’ implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate’s concurrent and long-term relationships with clinicians’ use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Methods Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians’ evidence-based practice use at baseline and at 2-year follow-up. Results In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians’ use of evidence-based practice at either time point. Conclusions Optimizing clinicians’ implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.http://link.springer.com/article/10.1186/s13012-018-0781-2Implementation climateMolar climateOrganizational climateCognitive behavioral therapyBehavioral healthEvidence-based practice
collection DOAJ
language English
format Article
sources DOAJ
author Nathaniel J. Williams
Mark G. Ehrhart
Gregory A. Aarons
Steven C. Marcus
Rinad S. Beidas
spellingShingle Nathaniel J. Williams
Mark G. Ehrhart
Gregory A. Aarons
Steven C. Marcus
Rinad S. Beidas
Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
Implementation Science
Implementation climate
Molar climate
Organizational climate
Cognitive behavioral therapy
Behavioral health
Evidence-based practice
author_facet Nathaniel J. Williams
Mark G. Ehrhart
Gregory A. Aarons
Steven C. Marcus
Rinad S. Beidas
author_sort Nathaniel J. Williams
title Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
title_short Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
title_full Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
title_fullStr Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
title_full_unstemmed Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
title_sort linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study
publisher BMC
series Implementation Science
issn 1748-5908
publishDate 2018-06-01
description Abstract Background Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians’ shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians’ shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians’ implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate’s concurrent and long-term relationships with clinicians’ use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Methods Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians’ evidence-based practice use at baseline and at 2-year follow-up. Results In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians’ use of evidence-based practice at either time point. Conclusions Optimizing clinicians’ implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.
topic Implementation climate
Molar climate
Organizational climate
Cognitive behavioral therapy
Behavioral health
Evidence-based practice
url http://link.springer.com/article/10.1186/s13012-018-0781-2
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