Abstract
BackgroundExternal change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare—specifically, in primary care settings.MethodsWe searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion.ResultsAcademic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes.ConclusionsOur results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn’t find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.
Highlights
External change agents can play an essential role in healthcare organizational change efforts
We have chosen to focus our analysis on organizational change efforts within primary care clinics which are often relatively small, community-based clinics that generally lack the kind of internal quality improvement resources that are relatively common in larger healthcare organizations
- Rates of completed screenings were higher for all practices for the most common screening methods, though rates of completed colonoscopy were higher in early clinics vs. delayed (p = 0.01)
Summary
External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare—in primary care settings. Change agents play an essential role in healthcare organizational change efforts In his influential book Diffusion of Innovations [1], Everett Rogers introduces the concept of change agents as people who “introduce innovations into a client system that they expect will have consequences that will be desirable, direct, and Alagoz et al BMC Health Services Research (2018) 18:42 direction. This systematic review seeks to provide useful information to health services and implementation researchers in designing effective implementation strategies that involve external change agents to promote change in primary care settings and community- based clinics.
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