scholarly journals Implementation in Nursing Homes: Describing Early and Late Adopters of an Evidence-Based Dementia Care Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 550-550
Author(s):  
Pamela Toto ◽  
Felicia Chew ◽  
Dawn Bieber ◽  
Natalie Leland ◽  
Cara Lekovitch
Keyword(s):  
Nursing Home ◽  
Diffusion Of Innovations ◽  
Readiness To Change ◽  
Quality Care ◽  
Clinical Trial Data ◽  
Care Program ◽  
Group Differences ◽  
Pragmatic Clinical Trial ◽  
Early Adopters ◽  
Organizational Readiness To Change

Abstract Despite national efforts to improve nursing home (NH) quality, care remains variable. Health system efforts to drive improvement often begin with a sub-group of NHs before scaling up across the organization. Yet, there is limited evidence on who to target for the first group. This study addressed this gap by examining facility characteristics of early and late adopters within a multi-site pragmatic clinical trial. Data were obtained from the Organizational Readiness to Change Assessment (ORCA), which was completed by expert trainers, and Nursing Home Compare. Early and late adoption was operationalized according to Roger’s Diffusion of Innovations. Sixty-percent of NHs (n=12) were late adopters and 40% (n=8) were early adopters. Between group differences (p<.01) were found in number of health inspection citations and context domain within the ORCA. These findings equip health systems with evidence on how to strategically target partners for initial quality improvement efforts prior to system-wide implementation.

scholarly journals ORGANIZATIONAL READINESS TO CHANGE AND NURSING HOME SAFETY: RESULTS FROM A NATIONAL SURVEY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S767-S768
Author(s):  
Christine W Hartmann ◽  
Emma Quach ◽  
Shibei Zhao ◽  
Valerie Clark ◽  
Sarah McDannold ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Safety Climate ◽  
Readiness To Change ◽  
Intraclass Correlation ◽  
Organizational Readiness ◽  
Assessment Instrument ◽  
Organizational Level ◽  
Residual Variance ◽  
Organizational Readiness To Change

Abstract In nursing homes, safety climate (employee attitudes and beliefs about safety) is a key contributing factor to safety and a potential leverage point for improvement. Yet relatively little is known about how contextual factors such as organizational readiness to change affect safety climate. We sampled employees from 56 Department of Veterans Affairs (VA) Community Living Centers (CLCs—nursing homes) and conducted an anonymous, cross-sectional web-based survey using the previously validated CLC Employee Survey of Attitudes about Resident Safety (CESARS) and the Organizational Readiness to Change Assessment instrument. From hierarchical mixed random effects regression models, we calculated intraclass correlation coefficients (ICC) as the proportion of CLC-level variance over the sum of CLC-level plus residual variance. Each of the CESARS’ 7 safety climate domains was a dependent variable in separate models; employee- and CLC-level factors were independent variables. The survey had a 26% response rate; 1,397 respondents. Mean ORCA scores (1-5 scale, higher better) was 3.3. We began with models containing only employee-level variables. ICC values ranged from 2.34% to 9.85%, suggesting substantial variation in CESARS outcomes. As we dropped insignificant variables and added CLC-level variables to the models, the ICC decreased over 2% in six models, suggesting organizational-level variables accounted for substantial variability. The only independent variable with a significant effect in all 7 models was organizational-level: organizational readiness to change. Unlike many other organizational-level variables, organizational readiness to change is potentially amenable to low-cost interventions such as communication and teamwork interventions, providing viable opportunities to efficiently improve nursing home care.

scholarly journals Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory

10.2196/23660 ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. e23660
Author(s):  
Markus W Haun ◽  
Isabella Stephan ◽  
Michel Wensing ◽  
Mechthild Hartmann ◽  
Mariell Hoffmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
General Practitioners ◽  
Diffusion Of Innovations ◽  
Significant Proportion ◽  
The United States ◽  
Diffusion Of Innovations Theory ◽  
Early Adopters ◽  
Adopter Categories

Background Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective This mixed method preimplementation study aims to assess GPs’ intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (β=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. Conclusions A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs.

scholarly journals Building Public Health System Capacity for Diabetes and Hypertension Care in Western Kenya

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Michael Harding ◽  
Matthew Turissini
Keyword(s):  
Care Delivery ◽  
Quality Care ◽  
Glucose Monitoring ◽  
Organizational Capacity ◽  
Care Program ◽  
System Capacity ◽  
Noncommunicable Diseases ◽  
Record System ◽  
Western Kenya ◽  
Levels Of Care

Background and Hypothesis: In western Kenya, estimates for prevalence of hypertension are 6-24% and diabetes are 3-5%. Complications of hypertension and diabetes are some of the fastest growing causes of morbidity and mortality in Kenya. There is limited knowledge and poor training pertaining to noncommunicable diseases (NCDs) making treatment difficult. With shortages of physicians and mid-level providers, protocol driven nursing care of hypertension and diabetes has shown to be effective. Through partnerships with counties, the NCD care program has screened 134,923 and treated 12,566 individuals for diabetes and screened 238,078 and treated 29,377 individuals for hypertension. My summer project was to utilize Academic Model Providing Access to Healthcare’s (AMPATH) partnership with the Kenyan Ministry of Health (MOH) to improve access and quality of hypertension and diabetes care delivery at county MOH facilities. These improvements can be achieved through increasing our joint mentorship program led by AMPATH and county MOH staff; introducing the AMPATH Medical Record System (AMRS) into county clinics to improve care; and quality improvement with the Home Glucose Monitoring team. Personal Role: I created Standard Operating Procedures (SOPs) for Integrative Screening, Clinical Mentorship, and Home Glucose Monitoring (HGM); designed a user manual for AMRS; helped develop a M&E plan for the HGM program; and assisted in the authorship of a grant to scale mentorship for diabetes and hypertension to 60 more clinical sites. Conclusion and Potential Impact: This project is a product of the partnership of AMPATH and the MOH to make accessible, high-quality care for hypertension and diabetes available across levels of care. By partnering with the Kenyan government and implementing care in the public sector, improvements in care are sustainable. My involvement will facilitate scaling the project to treat more patients through improving organizational capacity and helping apply for funds to implement in new areas.  

Using Diffusion of Innovations Theory to Encourage Workers to Make Healthy Food Choices and Engage in Physical Activity

2017 ◽  
pp. 1781-1793
Author(s):  
Debra N. Weiss-Randall
Keyword(s):  
Diffusion Of Innovations ◽  
Healthcare Costs ◽  
Saturated Fat ◽  
Diffusion Of Innovations Theory ◽  
Early Adopters ◽  
Healthy Behaviors ◽  
Daunting Task ◽  
Doi Theory

Employers want workers to be as healthy as possible, to reduce absenteeism and to boost productivity. The challenge is getting employees to adopt healthy behaviors, a daunting task in our obesogenic society, which promotes a sedentary lifestyle and a diet high in saturated fat, sodium, and sugar. We are seeing an epidemic of obesity and type 2 diabetes, two preventable diseases that impair quality of life and increase healthcare costs. Rogers' Diffusions of Innovations (DOI) theory explains how and why people adopt new behaviors. Rogers observed how some workers were resistant to change. He categorized people according to how long it took them to adopt an innovation. He found that certain attributes were characteristic of early adopters, the opinion leaders that organizations need to win over to facilitate acceptance of an innovation. This chapter explores how DOI theory can be applied to the workplace to promote healthy behaviors.

Impact of culture on organizational readiness to change: context of bank M&A

2019 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Arbind Samal ◽  
Sabyasachi Patra ◽  
Devjani Chatterjee
Keyword(s):  
Banking Sector ◽  
Readiness To Change ◽  
Higher Order ◽  
Organizational Readiness ◽  
Cultural Dimensions ◽  
Practical Utilization ◽  
Content Type ◽  
Individual Level ◽  
The Individual ◽  
Organizational Readiness To Change

Purpose The purpose of this paper is to examine the influence of culture on organizational readiness to change (ORC) within the context of merger and acquisition (M&A) in the banking sector in India. Design/methodology/approach A multisource approach is used to collect data from a public-sector bank in India for testing our hypothesis. A hierarchical approach based on higher-order modelling has been deployed for confirming the path model. The foundation of the study is based on power distance (PD) and uncertainty avoidance (UA) cultural dimensions of Hofstede (1984). Findings Employees in organizations with large PD and high UA index exhibit low readiness to change. Findings support a negative relationship of culture (large PD and high UA) with organizational readiness to change at the individual level. Research limitations/implications The study has three major implications. First, measures and importance of change readiness at the individual level during corporate events such as M&A is elucidated in the study. Second, a paradigm for assessing higher-order models grounded in theoretical and methodological rigour for testing our hypothesis is presented in the paper. Last, the role of culture in M&A processes is highlighted vis-à-vis factors related to PD and UA on ORC. Practical implications The findings of the research answer to the call for a study on factors that help in creating a synergy for successful M&A across all sectors especially in the banking sector. People representing high UA and large PD often look forward to direction and guidelines for guiding employee actions. Leaders therefore need to set clear agenda and effectively communicate the appropriateness of change to their employees for developing positive behaviour towards desirable organizational outcomes. This study touches upon this important perspective for its practical utilization. Originality/value The study adds to the limited literature on change which addresses the need for studying socio-cultural factors in the M&A process, especially in an emerging economies context.

scholarly journals COMPARISON OF NURSING HOME STAFF’S PERCEPTIONS OF NOISE TO MEASURED NOISE LEVELS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S277-S277
Author(s):  
April Ames ◽  
Stacie Dubin ◽  
Michael Valigosky ◽  
Victoria Steiner
Keyword(s):  
Nursing Home ◽  
Complex Analysis ◽  
Quality Care ◽  
Nursing Facilities ◽  
Noisy Environment ◽  
Healthcare Staff ◽  
Noise Levels ◽  
Noise Sources ◽  
Provide Quality Care ◽  
Nursing Home Facilities

Abstract A noisy environment may affect the ability of healthcare staff in nursing facilities to effectively complete tasks and provide quality care to residents. Staff may also become irritable or annoyed due to their perception that noise levels are too loud. The purpose of this descriptive study was to examine the differences in nursing home staff’s perceptions of noise levels compared to measured noise levels in four nursing home facilities in Ohio. A questionnaire was also distributed to examine the perceptions of noise levels by staff and the effects of noise on their health. The majority of the respondents (n=90) were white females. They described all facilities as being moderately noisy which was consistent with the measured noise levels. The loudest perceived noise sources included door/patients alarms and floor cleaners, which was confirmed by measured noise levels. The majority of facilities identified the nurses station as one of the noisiest locations; however, this was inconsistent with measured noise levels. Overall, respondents at all facilities felt neutral or disagreed that the noise levels impacted themselves or the residents. However, some respondents agreed that in a noisy environment it is easier to make job errors, difficult to concentrate on work, and they find themselves irritable or agitated. Perceptions of noise should be considered along with measured noise levels because tolerance levels differ among individuals and mental activities involving memory or complex analysis are sensitive to noise which may affect job performance.

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