Assessing organizational readiness for depression care quality improvement: relative commitment and implementation capability.

Lisa V Rubenstein,A Lauren Crain,Robin R Whitebird,Leif I Solberg,Marjorie S Danz,Russell E Glasgow

doi:10.1186/s13012-014-0173-1

Abstract

BackgroundDepression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice’s commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability.MethodsThe DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements.ResultsAll five implementation capability measures independently predicted practice leaders’ relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p <0.001), prior depression quality improvement activities (p <0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative.ConclusionsThe study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders’ relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0173-1) contains supplementary material, which is available to authorized users.

Highlights

Depression is a major cause of morbidity and cost in primary care patient populations
We empirically investigate key concepts from the organizational readiness for change literature [13,14] as an approach for understanding variations in initiating depression care improvement, the necessary first step for successful collaborative care implementation
Practice demographic characteristics Among the primary care practices participating in the DIAMOND initiative, just over half of the 83 included in this dataset (57%) were from the Twin Cities metropolitan area

Summary

Introduction

Depression is a major cause of morbidity and cost in primary care patient populations. The highly evidence-based, multicomponent depression collaborative care model, for example, focuses on trained care managers, enhanced mental health specialty/primary care collaboration, and patient self-management support [4,5]. This model may require between 3 months and a year to implement, even with leadership commitment and availability of tools and assistance [6]. We empirically investigate key concepts from the organizational readiness for change literature [13,14] as an approach for understanding variations in initiating depression care improvement, the necessary first step for successful collaborative care implementation

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