Phyllis C. Panzano, Ph.D. , PI Dee Roth, M.A., Co-PI
Bev Seffrin, Ph.D, Senior Consultant Dushka Crane-Ross, Ph.D., Project Manager
Decision Support Services, Inc. Ohio Dept of Mental Health, OPER
The Innovation Diffusion and Adoption
Research Project (IDARP)
ODMH RESEARCH RESULTS BRIEFING 2003
Funded by the ODMH & the Mac Arthur Foundation
Ohio’s Quality Agenda
Best
Pr
actic
es
Outcomes
QI
Evid
en
ce B
ase
Salience
Coordinating Centers of Excellence (CCOEs)
Evid
en
ce B
ase
Salience
Advance Directives
MH/Schools
MH/Criminal Justice OMAP
Family Psychoeducation
Cluster-Based Planning
MST SAMI-IDDT
o University or local partnership
o One Best Practice per CCOE
o Statewide service area
Structure of CCOEs
o Promotion of Best Practices
o Education & training
o Capacity development
o Fidelity measurement
o Cross-system sharing
Role of CCOEs
What factors and processes influence
the adoption, assimilation, and
impact of evidence-based practices by
mental health provider organizations?
Research Question
o Characteristics of the Best Practice
o Adoption Decision & Implementation Process
o Adopting Organization
o Adopting Organization – CCOE Relationship
Independent Variables
Research Team
Decision Support Services, Inc.
Phyllis Panzano, Ph.D
Beverly Seffrin, Ph.D.
Sheri Chaney, M.A.
Vandana Vadyanathan, M.A.
Sheau-yuen Yeo, M.A.
Ohio Dept of Mental Health
Dee Roth, M.A.
Dushka Crane-Ross, Ph.D.
Rick Massatti, M.A.
Carol Carstens, Ph.D.
Ohio State University: Fisher College of Business Department of Psychology
Theoretical Background
o Numerous literatures are relevantNumerous literatures are relevant
o Resulting Assumptions:Resulting Assumptions:
o EBPs are innovationsEBPs are innovations
o Scientific evidence necessary but not Scientific evidence necessary but not
sufficientsufficient
o Upper Echelon Theory relevantUpper Echelon Theory relevant
o Implementation effectiveness Implementation effectiveness Innovation Innovation
effectivenesseffectiveness
o Factors at many “levels” impact outcomesFactors at many “levels” impact outcomes
o 3 phases: initiation; decision; 3 phases: initiation; decision;
implementationimplementation
idarp
100-PIECE JIGSAW PUZZLE
COMPLEXITY
IDARP Models
Model 1:
Adoption Decision –Decision making under risk
Phase 1: Decision Under Risk
• IMPLEMENT
• ADOPTER
• WAIT & SEE
• NEVER
Perceived
Risk of
Adopting
Capacity to
Manage or
Absorb RiskRisk-
taking
Propensity
-
+
+
ANTECEDENTS
More
Likely
Less Likely
LIKELIHOOD OF
IMPLEMENTING
Model 2: Multi-level Influences on Implementation Success
Interested in Two Classes of Outcomes
o Measures of Measures of InnovationInnovation effectiveness: effectiveness:
Benefits that accrue to an organization and its Benefits that accrue to an organization and its
stakeholders as a result of implementing an innovative stakeholders as a result of implementing an innovative
practice (positive consequences for clients, staff, etc.)practice (positive consequences for clients, staff, etc.)
o Measures of Measures of ImplementationImplementation effectiveness: effectiveness:
Accurate, committed and consistent use of Accurate, committed and consistent use of
practice practice
by targeted employees (assimilation, fidelity, by targeted employees (assimilation, fidelity,
etc.)etc.)
Expected Link Between Two Classes of Outcomes
IMPLEMENTATION EFFECTIVENESS
INNOVATION EFFECTIVENESS
For example:
IMPLEMENTATION EFFECTIVENESS
INNOVATION EFFECTIVENESS
FIDELITY POSITIVEOUTCOMES
Variables at multiple levels are expected to impact these
two classes of outcomes
Examples of Variables by Level
Level ExampleENVIRONMENTENVIRONMENT System and professional norms System and professional norms
IOR (Org with CCOE)IOR (Org with CCOE) Quality of communicationQuality of communication
ORGANIZATIONORGANIZATION Learning cultureLearning culture
PROJECT PROJECT
Re: OrganizationRe: Organization
Re: DecisionRe: Decision
Re: Re: ImplementationImplementation
Availability of dedicated resourcesAvailability of dedicated resources
Commitment to decision to adoptCommitment to decision to adopt
Access to technical assistanceAccess to technical assistance
INNOVATIONINNOVATION Scientific supportScientific support
Experiential evidenceExperiential evidence
Level 4: Inter-organizational
Level 3: Adopting organization
Level 2: Project level
Level 1: Innovation level
Dependent Variables:
• Implementation effectiveness
• Innovation effectiveness
Level 5: EnvironmentModel 2
Model 3:
Cross-Phase Effects on Cross-Phase Effects on Implementation OutcomesImplementation Outcomes
INITIATION Decision
IMPLEMENTATION Outcomes
Time
Model 3: Cross-phase effects
Experiential Evidence
Objective Process
Access to Technical
Assistance
Positive Consequen
ces
Time
Model 3: Examples of Cross-phase Effects
Initiation Decision
Implementation
Model 4:
Effects of Implementation Effects of Implementation Variables on Outcomes Variables on Outcomes
Over TimeOver Time
PRESENT OUTCOMES
Model 4: Effects of Implementation Variables Over Time
PAST
Implementation
PRESENT
Implementation
TIME
PRESENT OUTCOMES
Model 4: Examples of Effects of Implementation Variables Over
Time
PAST
Access to Technical
Assistance
PRESENTDedicated Resources
TIME
Methods & Progress to Date
Four CCOEs Participating
Selection criteria maximize generalizabilitySelection criteria maximize generalizability
1)1) Cluster-Based Planning Alliance Cluster-Based Planning Alliance
2)2) Multi-systemic Therapy (CIP)Multi-systemic Therapy (CIP)
3)3) Ohio Medication Algorithm Project Ohio Medication Algorithm Project
4)4) Integrated Dual Disorder Treatment (IDDT) –Integrated Dual Disorder Treatment (IDDT) –New Hampshire - Dartmouth model New Hampshire - Dartmouth model
Research Design
o Longitudinal studyLongitudinal study
o Organizations at different stages of Organizations at different stages of adoptionadoption
o Multiple key informants at each Multiple key informants at each organizationorganization
o Quantitative and qualitative dataQuantitative and qualitative data
o Interviews, surveys & archival dataInterviews, surveys & archival data
Participating Projects*by Type of Innovation
23
37
16 15
0
10
20
30
40
Fre
quen
cy
MST
OM
AP
IDD
T/SA
MI
Clu
ster
Alli
anc
e
*18 organizations involved in multiple projects; Total of 74 organizations with 91 projects under study.
Participating Projectsby Stage of Adoption at Time One
12 179
47
605
101520253035404550
Fre
quen
cy
Impl
emen
ter
De-
adop
ter
Ado
pter
Nev
erW
ait &
see
N = 91
Participating Projectsby Stage of Adoption at Time Two
1 1 2
42
405
101520253035404550
Fre
quen
cy
Impl
emen
ter
De-
adop
ter
Ado
pter
Nev
erW
ait &
See
N = 50
Key Informants by Level at Time One
45
10781
6175
0
25
50
75
100
125
Fre
quen
cy
CFO
/QA
Impl
emen
ter
Dec
isio
n m
aker C
CO
E
Com
mun
ity
Col
labo
rative
N = 369
Key Informants by Level at Time Two
1139
64
210
25
50
75
100
125
Fre
quen
cy
Impl
emen
ter
Dec
isio
n m
aker
CCO
E
Com
mun
ity
Col
labo
rative
N = 135
Findings
622
agree
Strongly disagree
Very satisfied
$ 37,500
Do the data support our four models?
THE TIP….OF THE TIP
___________________________________
POSITIVE CORRELATION
As the value of one variable increases,
the value of a second variable also increases
Median Income
Years of Formal Education
Lower
Higher
Less More
+ correlation (r = +1.00)
___________________________________
NEGATIVE CORRELATION
As the value of one variable increases,
the value of a second variable decreases
Unemployment
Rate
Years of Formal Education
Lower
Higher
Less More
- correlation (r = -1.00)
___________________________________
ZERO ‘0’ CORRELATION
The relationship between the value of one variable and the value of a second variable is
random
Years of Formal Education
Shorter
Taller
Less More
Zero Correlation
Height
x
x
x
x
x
x
x
x
x
x
x
x
x
x x
x
x
(r = 0.00)
___________________________________
CORRELATION CANNOT BE DETERMINED
because the value of one (or both) variable(s) is constant or almost constant
Lower
Higher
Years of Formal Education = BA, BS
Unemployment
Rate
The Adoption Decision (Model 1)
Time 1/First contact data
Phase 1: A Decision Under Risk
Likelihood of implementing as
indicated by Stage
Implementer Adopter Wait & See Never
Perceived
Risk of
Adopting
Capacity to
Manage or
Absorb Risk
Risk-taking
Propensity
-.51
+.38
+.20
Antecedents to Risk Perceptions
Likelihood of implementing as
indicated by Stage
Implementer Adopter Wait & See Never
Perceived
Risk of
Adopting
Capacity to
Manage
Risk
Risk-taking
Propensity
-.51
+.38
+.20
ANT E C E D ENT S
Antecedents to Perceived Risk
Perceived
Risk
Innovation Level Factors
• Relative Advantage
• Scientific Evidence
• Experiential Evidence
Org-Level Factors
• Knowledge Set
-.20
-.30
-. 43
-.51
Environmental Factors
• Norms for Adoption
-.45
Antecedents to Risk Management
Capacity to
Manage Risk
EBP–Level Factors
Ease of Use
Org–Level Factors
Top Mgmt. Support
Environmental Factors
Environmental uncertainty
+ .45
+ .50
- .22
Craft Skills+ .2
5
Dedicated Resources
+ .63
Antecedents to Risk Propensity
Organization-Level Factors
Learning Encouragement
Managerial Attitude
About Change
Risk
Propensity
+.71
+.23
Summing Up: Model 1
3. Antecedents have implications for action3. Antecedents have implications for action
1. Adoption decision is a decision 1. Adoption decision is a decision involving riskinvolving risk2. Organizations are more likely to adopt 2. Organizations are more likely to adopt if:if:
Perceived risk of adopting is lowPerceived risk of adopting is low
Capacity to manage risk is highCapacity to manage risk is high
Propensity to take risks is highPropensity to take risks is high
Model 2: Implementation Phase
Understanding Outcomes of Understanding Outcomes of Implementation Implementation
for Adopters and Implementersfor Adopters and Implementers
Time 2/Second Contact Data
Two classes of outcomes
1. Implementation Effectiveness
(e.g., fidelity, assimilation)
2. Innovation/practice Effectiveness
(e.g., positive outcomes)
Is implementation effectiveness related to innovation effectiveness?
IMPLEMENTATION EFFECTIVENESS
INNOVATION EFFECTIVENESS
Reinvention1
Positive outcomes
?
-.64
Assimilation Positive outcomes
.61
1 Self report; reflects extent to which practice was modified
Level 4: Inter-organizational
Level 3: Adopting organization
Level 2: Project level
Level 1: Innovation level
Dependent Variables:
• Implementation effectiveness
• Innovation effectiveness
Level 5: Environmental Model 2
Assimilation: One measure of
implementation effectiveness
Is Assimilation Explained by Variables at Multiple Levels?
DYAD: Communication quality +.45
ORG: Learning culture +.30
Centralization +.43
PROJECT: Dedicated resources +.52
Ease of use +.40
INNOV: Fit w/Tx philosophy +.45
Dependent Variable: Assimilation*
* Extent practice seen as part of permanent operations
Some Examples
Variables at multiple levels are related to reported
assimilation.
Are views about positive outcomes explained by
variables at multiple levels?
Positive outcomes
Overall positive consequencesOverall positive consequences Positive outcomes for consumersPositive outcomes for consumers Positive impact on organization’s imagePositive impact on organization’s image Positive impact on organization Positive impact on organization
functioningfunctioning Overall positive impactOverall positive impact Extent expectations realizedExtent expectations realized
DYAD: Identification +.40 to +.60
ORG: Risk mgmt. +.27 to +.40
PROJECT: Perf. monitoring +.52 to +.74
Access to TA +.48 to +.66
Reinvention -.24 to -.49
INNOV: Scientific evidence +.30 to +.60
Dependent Variable: Positive Outcomes
Some Examples
Variables at multiple levels are related to perceived positive outcomes.
Model 3: Cross-Phase Effects on Implementation Outcomes
Understanding Effects of Initiation-Phase Understanding Effects of Initiation-Phase and Decision-Phase Variables on and Decision-Phase Variables on
Implementation Outcomes Implementation Outcomes
INITIATION Decision
IMPLEMENTATION Outcomes
Outcomes
TimeTimeTimeTime
Model 3: Cross-Phase Effects Cross-Phase Effects on Implementation Outcomeson Implementation Outcomes
Time 1Time 1 Time 1Time 1 Time 2Time 2
INITIATION(Time 1)(Time 1)
Decision
IMPLEMENTATION OutcomeOutcomess
(Time 2)
OutcomeOutcomess
(Time 2)
TimeTime
Model 3: Initiation-Phase Initiation-Phase EffectsEffects
Expected Benefits +.44Relative advantage +.63Trust CCOE +.46Results demonstrability +.49
Assimilation
Initiation-Phase Effects
Expected Benefits +.58 to +.69Relative advantage +.59 to +.74 Trust CCOE +.38 to +.57Results demonstrability +.26 to +.51
Positive Outcomes
Initiation-Phase Effects
INITIATION Decision
(Time (Time 1)1)
IMPLEMENTATION
TimeTime
Model 3: Decision-Phase EffectsDecision-Phase Effects
Outcomes
(Time 2)
Outcomes
(Time 2)
Objective decision +.37Information access +.34Internal influence +.28Organizational commitment +.37
Assimilation
Decision-Phase Effects
Objective decision +.46 to +.71Information access +.42 to +.61Internal influence +.31 to +.46Organizational commitment +.42 to +.52
Positive Outcomes
Decision-Phase Effects
Variables in earlier phases can have enduring effects on
implementation outcomes.
Model 4: Understanding Effects of Implementation-Phase Variables Over Time
PRESENT OUTCOMES
Model 4: Effects of Implementation Variables Over Time
PAST
Implementation
PAST
Implementation
PRESENT
Implementation
PRESENT
Implementation
TIME
Model 4: Effects of Implementation Variables Over Time
PAST
Top Support
PAST
Top Support
PRESENT
Top Support
PRESENT
Top Support
TIME
PRESENT OUTCOMES
Model 4: Effects of Implementation Variables Over Time
PAST
Freedom to Express Doubt
PASTFreedom to
Express Doubt
PRESENTFreedom to
Express Doubt
PRESENTFreedom to
Express Doubt
TIME
PRESENT OUTCOMES
Model 4: Effects of Implementation Variables Over Time
PAST
Access to Technical
Assistance
PASTAccess to Technical
Assistance
TIME
PRESENT OUTCOMES
PRESENTAccess to Technical
Assistance
PRESENTAccess to Technical
Assistance
Model 4: Effects of Implementation Variables Over Time
PAST
Dedicated Resources
PASTDedicated Resources
PRESENTDedicated Resources
PRESENTDedicated Resources
TIME
PRESENT OUTCOMES
Implementation strategies need to be sustained in order to have positive impacts on long-term
outcomes.
Shifting Gears:Comparing Different EBPs
at Time One
Do adopting organizations hold similar views about the four
practices?
Clustering Clustering (n = 23)(n = 23) MST MST (n = 16)(n = 16) OMAP OMAP (n = 15)(n = 15) IDDT/SAMI IDDT/SAMI (n = 16)(n = 16) IDDT/SAMI with Initial Funding IDDT/SAMI with Initial Funding (n = (n = 1212**))
* 9 funded demonstrations; 12 projects
Organization: Organizational Commitment
MST, IDDT & IDDT-FUNDED > OMAP
5.4 6.15 5.7 5.9
0
1
2
3
4
5
6
7
Adopter
Strongly Agree
StronglyDisagree
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Innovation: Experiential Evidence MST, IDDT-FUNDED & IDDT > CBP > OMAP
4.86
4.15.5 5.8
0
1
2
3
4
5
6
7
Adopter
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Strongly Agree
StronglyDisagree
Innovation: Scientific Evidence MST, IDDT-FUNDED & IDDT > CBP & OMAP
4.76.4
4.55.9 6.3
0
1
2
3
4
5
6
7
Adopter
Strongly Agree
StronglyDisagree
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Innovation: Magnitude of Change Required to Implement
MST, IDDT-FUNDED & IDDT > CBP & OMAP
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
4.78
2.66.4 6.5
0
3
6
9
12
15
Adopter
Innovation: Fidelity Seen as Crucial to
Implementing the Practice MST > OMAP, CBP, IDDT & IDDT-FUNDED
3.95.4
4.4 3.8 3.5
0
1
2
3
4
5
6
7
Adopter
Strongly Agree
StronglyDisagree
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Implementation: Resources* for Initial Implementation
No differences
4.2 4.7 5 4.75.5
0
1
2
3
4
5
6
7
Adopter
Strongly Agree
StronglyDisagree
* money, personnel & time
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Implementation: Resources* for Ongoing Implementation OMAP > CBP, MST & IDDT > IDDT-FUNDED
4.2 4.25 4.4
3.4
0
1
2
3
4
5
6
7
Adopter
Strongly Agree
StronglyDisagree
* money, personnel & time
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Implementation: Problems Recruiting Staff
MST > CBP, OMAP, IDDT & IDDT-FUNDED
3
8
3.6 4 4.9
0
2
4
6
8
10
Adopter
GreatExtent
No Extent
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Implementation: Reinvention No differences
2.8 2.3 2.8 3.3 3.5
0
1
2
3
4
5
6
7
Adopter
Very GreatExtent
No Extent
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
Outcome: Assimilation CBP, OMAP & IDDT > IDDT-FUNDED
5.85 5.7 6
4.3
0
1
2
3
4
5
6
7
Adopter
Very GreatExtent
No Extent
Clu
ster
ing
IDD
T
IDD
T-Fu
nded
MST
OM
AP
A peek at
interview data
Approach
Interview team produces transcripts from Interview team produces transcripts from interviews with multiple agency sourcesinterviews with multiple agency sources
Qualitative Qualitative “codes”“codes” attached to text in Atlas Ti attached to text in Atlas Ti Software program such as:Software program such as:
Issue diagnosis & decision processIssue diagnosis & decision process Planning process for EBP implementationPlanning process for EBP implementation Facilitators & BarriersFacilitators & Barriers Expected/unexpected, +/- outcomesExpected/unexpected, +/- outcomes
Unit of Analysis =Unit of Analysis = “mentions” “mentions” or coded phrasesor coded phrases
Focus of today’s look at qualitative data
Data collected during time one/first contact Data collected during time one/first contact with 36 projects (~ 3 interviews per)with 36 projects (~ 3 interviews per)
Projects X StageProjects X Stage 18 Implementers18 Implementers 7 Adopters7 Adopters 7 Wait & See/Never 7 Wait & See/Never 4 De-adopters4 De-adopters
Projects X EBPProjects X EBP 13 IDDT13 IDDT 9 Cluster-Based Planning9 Cluster-Based Planning 7 OMAP7 OMAP 7 MST7 MST
Glossary of Categories
CCOECCOE - relating to the CCOE, its staff and - relating to the CCOE, its staff and services it provides.services it provides.
EBPEBP – perceptions relating to the innovation. – perceptions relating to the innovation.
MoneyMoney - expenses (actual or anticipated), - expenses (actual or anticipated), funding of the EBP and financial issues that funding of the EBP and financial issues that impact the agency.impact the agency.
Staff Staff - reactions, recruitment, retention and - reactions, recruitment, retention and qualifications of staff. qualifications of staff.
System System - coordination, collaboration, and - coordination, collaboration, and interest in Mental Health and other related interest in Mental Health and other related systems.systems.
CCOE: Major Themes
Facilitators (n = 119)Facilitators (n = 119)
Attended CCOE Attended CCOE presentation/became presentation/became aware of CCOE/had aware of CCOE/had previous experience previous experience with (n = 55)with (n = 55)
CCOE provides CCOE provides instrumental help instrumental help (n = 50)(n = 50)
Positive reaction to Positive reaction to CCOE (n = 11)CCOE (n = 11)
Barriers (n = 36)Barriers (n = 36)
CCOE doesn’t CCOE doesn’t understand the understand the agency’s issues or agency’s issues or constraints (n = 9)constraints (n = 9)
CCOE: Mentions by Stage
20
51
11
37
5
27
220
25
50
75
100
125
150
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
EBP: Major Themes
Facilitators (n = 225)Facilitators (n = 225)
Received training or Received training or information (n = 53)information (n = 53)
EBP is good match with EBP is good match with culture, systems, or culture, systems, or similar to what we similar to what we already do (n = 24)already do (n = 24)
EBP might be useful EBP might be useful (n = 19)(n = 19)
Barriers (n = 153)Barriers (n = 153)
Don’t know how to Don’t know how to proceed – in the dark proceed – in the dark (n = 24)(n = 24)
EBP isn’t a good fit to EBP isn’t a good fit to this organization this organization (n = 13)(n = 13)
EBP might NOT be EBP might NOT be useful (n = 13)useful (n = 13)
EBP: Mentions by Stage
135
31 11
48
19
85
2227
0
25
50
75
100
125
150
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Money: Major Themes
Facilitators (n = 69)Facilitators (n = 69)
Received funds (n = Received funds (n = 31)31)
Identified potential Identified potential funds (n = 24)funds (n = 24)
There is a potential There is a potential savings from the EBP savings from the EBP (not necessarily for the (not necessarily for the agency) (n = 6)agency) (n = 6)
Barriers (n = 115)Barriers (n = 115)
Agency has financial Agency has financial issues/EBP costs issues/EBP costs money (n = 80)money (n = 80)
Funding for the EBP is Funding for the EBP is not sustainable (n = not sustainable (n = 29)29)
Our funding Our funding shrunk/was lost/ended shrunk/was lost/ended (n = 11)(n = 11)
Money: Mentions by Stage
1
37
1219
3344
2018
0
25
50
75
100
125
150
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Staff: Major Themes Facilitators (n = 122)Facilitators (n = 122)
Staff is interested/ Staff is interested/ supportive/likes the supportive/likes the EBP (n = 25)EBP (n = 25)
Staff hired for program Staff hired for program (n = 18) (n = 18)
Staff thinks the EBP Staff thinks the EBP makes sense (n = 8)makes sense (n = 8)
Barriers (n = 171)Barriers (n = 171)
Recruitment & Recruitment & turnover issues (n = turnover issues (n = 67)67)
Resistance to EBP, Resistance to EBP, skepticism, lack of skepticism, lack of interest (n = 44)interest (n = 44)
Competing priorities Competing priorities (e.g. innovation vs. (e.g. innovation vs. productivity) (n = 15)productivity) (n = 15)
Staff: Mentions by Stage
82
5 10
25 24
112
1619
0
25
50
75
100
125
150
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
System: Major Themes
Facilitators (n = 106)Facilitators (n = 106)
Support and interest in Support and interest in the system (n = 34)the system (n = 34)
Collaboration/ Collaboration/ cooperation/ cooperation/ communication & communication & integration in the integration in the system (n = 33)system (n = 33)
Barriers (n = 82)Barriers (n = 82)
Lack of support/no Lack of support/no interest (n = 29)interest (n = 29)
Conflict, lack of Conflict, lack of collaboration between collaboration between important entities, no important entities, no communication (n = 29)communication (n = 29)
Competing priorities & Competing priorities & turmoil in system (n = turmoil in system (n = 9)9)
System: Mentions by Stage
42
107
47
21
32
1712
0
25
50
75
100
125
150
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Summing Up: Facilitator/Barrier Analysis - Category
0
175
350
525
700
Facilitators Barriers
Overall, facilitators Overall, facilitators were mentioned were mentioned more often than more often than barriers (641:557).barriers (641:557).
EBP: The category EBP: The category with the most with the most mentions of mentions of facilitators (225);facilitators (225);
Staff: The category Staff: The category with the most with the most mentions of mentions of barriers (171).barriers (171).
CCOE
EBP
$
Staff
System
CCOE
EBP
$
StaffSystem
Facilitator & Barrier Analysis -Phase
Facilitators and barriers can usually be Facilitators and barriers can usually be identified as occurring during specific identified as occurring during specific phasesphases of the process. of the process.
The next analysis separates most of the The next analysis separates most of the same “mentions” in terms of phase in same “mentions” in terms of phase in which they occurred.which they occurred.
Facilitator & Barrier Analysis – Initiation Phase
Initiation PhaseInitiation Phase – A facilitator or barrier – A facilitator or barrier that is anticipated or experienced PRIOR that is anticipated or experienced PRIOR to the adoption decision. to the adoption decision.
Initiation PhaseInitiation Phase Facilitators = 229 Facilitators = 229 Initiation PhaseInitiation Phase Barriers = 91 Barriers = 91
Mentions during Initiation Phase
7655
16
82
3
30
18
40
0
25
50
75
100
125
150
175
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Early in the Implementation Phase
Early ImplementationEarly Implementation – A facilitator or – A facilitator or barrier that is anticipated or barrier that is anticipated or experienced AFTER the adoption experienced AFTER the adoption decision, but before full implementation. decision, but before full implementation.
Early ImplementationEarly Implementation Facilitators = 166 Facilitators = 166 Early Implementation Early Implementation Barriers = 122Barriers = 122
Mentions during Early Implementation
103
011
52
15
76
31
00
25
50
75
100
125
150
175
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Implementation Phase
ImplementationImplementation – A facilitator or barrier – A facilitator or barrier that is anticipated or experienced that is anticipated or experienced AFTER the agency begins to implement AFTER the agency begins to implement the EBP.the EBP.
ImplementationImplementation Facilitators = 155 Facilitators = 155 ImplementationImplementation Barriers = 250 Barriers = 250
Mentions during Implementation Phase
133
020
2
76
162
120
0
25
50
75
100
125
150
175
Wait & See/
Never
Adopter Implementer Deadopter
Facilitators Barriers
Summing Up: Facilitator/Barrier Analysis - Phase
Initiation:Initiation: Facilitators are mentioned more Facilitators are mentioned more than TWICE AS FREQUENTLY as barriers.than TWICE AS FREQUENTLY as barriers.
Early Implementation:Early Implementation: Adopters & Adopters & Implementers mention 50% more facilitators Implementers mention 50% more facilitators than barriers (trend not seen in Wait & than barriers (trend not seen in Wait & See/Never or Deadopters).See/Never or Deadopters).
Implementation:Implementation: While there are more While there are more barriers than facilitators mentioned throughout barriers than facilitators mentioned throughout the Implementation phase, Deadopters the Implementation phase, Deadopters mention nearly FOUR TIMES more barriers mention nearly FOUR TIMES more barriers than facilitators.than facilitators.
So what does all this mean?
Major Messages
Adoption decision is a risky decision Adoption decision is a risky decision
Implementation effectiveness related to but Implementation effectiveness related to but not equal to innovation effectivenessnot equal to innovation effectiveness
Factors at many levels contribute to successFactors at many levels contribute to success
What happens early (e.g., during initiation) can What happens early (e.g., during initiation) can have enduring effects have enduring effects
Present implementation climate explains Present implementation climate explains present outcomespresent outcomes
SOME IMPLICATIONS