Abstract
BackgroundThe majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. This study explores the process of organizational—rather than EBP—adaptation during implementation and sustainment. To the authors’ knowledge, there are no previous implementation studies that focus on organizational adaptation in this way.MethodsThis analysis utilizes a case study approach to examine longitudinal qualitative data from 17 community-based organizations (CBOs) in one state and seven county-based child welfare systems. The CBOs had sustained a child-neglect intervention EBP (SafeCare®) for 2 to 10 years. The unit of analysis was the organization, and each CBO represented a case. Organizational-level profiles were created to describe the organizational adaptation process.ResultsThree organizational-level adaptation profiles were identified as follows: incorporators (n = 7), early investors (n = 6), and learners (n = 4). Incorporators adapted by integrating SafeCare into existing operations to meet contractual or EBP fidelity requirements. Early Investors made substantial organizational adaptations during the early implementation period, then operated relatively consistently as the EBP became embedded in the organization and service system. Learners were characterized by steady and continuous attention to new ways that the organization could adapt to support the EBP.ConclusionThe profiles demonstrated that there can be multiple effective paths to EBP sustainment. Organizational adaptation was calibrated to fit a CBO’s operations (e.g., size of the program) and immediate environmental constraints (e.g., funding levels). Additionally, organizations fulfilled different functional roles in the network of entities involved in EBP implementation. Knowing organizational roles and adaptation profiles can guide implementation planning and help to structure contract designs that bridge the outer (system) and inner (organizational) contexts. Adaptation profiles can also inform the intensity of the implementation strategy tailoring process and the way that strategies are marketed to organizations.
Highlights
The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP
Three organizational adaptation profiles were identified, “Incorporators,” “Early Investors,” and “Learners.” Table 4 illustrates the distribution of organizational-level profiles across the eight service systems
Organizational adaptation is an inherent part of EBP implementation, and this study is an essential step in developing theory that allows for the prediction of organizational adaptation behavior during EBP implementation
Summary
The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. Adaptation as changes to the evidence-based practice Dominant definitions emphasize adaptation as the systematic modification of an evidence-based practice (EBP) to fit provider characteristics, organizational contexts, and service settings [1,2,3]. Researchers have relied on this conceptualization of EBP adaptation to expand the literature in several important ways, including systematic reviews that explore methods and reasons for, outcomes of, and guidance around intervention adaptation [2, 6, 7]. New research suggests that EBP adaptation should be considered as a value equation in which the needs, preferences, and contingencies of stakeholders at system, organization, provider, and patient levels are taken into account [9]. We examine organizational adaptation as an ongoing process and explicitly address the internal changes that organizations make (i.e., their adaptations) to accommodate implementation of new EBPs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
