Impact of Organizational Stability on Adoption of Quality-Improvement Interventions for Diabetes in Primary Care Settings.

Abstract

Although there have been tremendous advances in diabetes care, including the development of efficacious interventions, there remain considerable challenges in translating these advances into practice. Four primary care networks (PCNs) in Alberta implemented 2 quality-improvement interventions focused on lifestyle and depression as part of the Alberta's Caring for Diabetes (ABCD) project. We used the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework to evaluate adoption of the quality-improvement interventions in the PCN setting. We undertook semistructured interviews with PCN staff (n=24); systematic documentation (e.g. field notes) and formal reflections by the research team (n=4). Content analysis was used to interrogate the data. The Ready? Set? Go! construct summarizes our findings well. We observed that the participating PCNs were in a favourable position to adopt the 2 interventions successfully. We implemented strategies to promote adoption (Ready), and respondents reported prioritization and willingness to initiate the interventions based on positive indicators (Set). Regardless, the interplay of organizational stability, leadership support, existing physician culture and organizational context influenced the overall degree ofadoption of the interventions across the PCNs (Go). Our findings suggest that implementation of quality-improvement interventions into settings similar to the PCNs we studied will have the greatest likelihood of success when there is priority alignment, genuine and sustained leadership support and an innovative organizational culture. However, the stability of organizations may affect the degree to which staff can adopt quality-improvement interventions successfully, so organizational stability should be assessed on an ongoing basis.