Organizational culture and climate profiles: relationships with fidelity to three evidence-based practices for autism in elementary schools

Nathaniel J. Williams,Lindsay Frederick,Gregory A. Aarons,Jill Locke,David S. Mandell,Rinad S. Beidas,Philip Green,Hannah E. Frank

doi:10.1186/s13012-019-0863-9

Abstract

BackgroundImplementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example.MethodsThe study included 65 elementary schools in the U.S. that implemented three EBPs—discrete trial training, pivotal response training, and visual schedules—for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes.ResultsControlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d’s = .95 to 1.64) and reported superior work attitudes (d’s = .71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles.ConclusionsOrganizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization’s overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.

Highlights

Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation
The goal of this study is to examine how overarching configurations or profiles of organizational culture and climate relate to fidelity of EBP implementation and to work attitudes that support the sustainment of EBPs
This study focuses on the implementation of three well-established EBPs for youth with autism delivered in public elementary schools in the U.S Little research has examined the relationships between culture and climate and fidelity to EBPs in schools [13, 14], despite the fact that schools comprise the single largest provider of behavioral health services for youth in the U.S [15, 16]

Summary

Introduction

Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. Theories and frameworks that explain the implementation of evidence-based practice (EBP) in health care construe an organization’s social context, including its culture and climate, as a general organizational characteristic that affects the organization’s overall functioning and employees’ skillful and effective use of targeted EBPs [1,2,3,4] Consistent with these theories and frameworks, research has linked several individual dimensions of culture and climate to the implementation of EBPs and to factors that support the sustainment of EBPs, such as staff job satisfaction, organizational commitment, and reduced turnover, across a wide range of healthcare settings (see [5] for a review).

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