Improve Service Outcomes Research Articles

IMPLEMENTASI PROGRAM PENGENDALIAN KEMATIAN BAYI DI KABUPATEN MUSI RAWAS UTARA

Background: The infant mortality rate is an indicator of the success of maternal and child health programs. The lower the infant mortality rate indicates the success of developing family health. Based on the 2020-2024 RPJMN, the infant mortality rate in 2019 (SDKI, 2017) was 24 per 1000 population births, it is hoped that it will decrease to 16 per 1000 population births in 2024. Health status and education levels have improved, but have not yet reached the entire population. Maternal and infant mortality is still high. The capacity of health workers, the maternal referral system, and the management of maternal and child health services, as well as reproductive health services, are not yet running optimally. Method: This research method is qualitative research using descriptive analysis. Research informants are divided into two, namely supporting informants and key informants. The number of informants was 12 people consisting of 0 key informants and 2 supporting informants. Results: The results of the research show that the background to the implementation of the program is not yet understood by health workers, while the goals and objectives of the program are in accordance with the regulations of the Ministry of Health. The implementation of the program has been carried out well, there is support from across sectors and across programs, but there are obstacles due to the characteristics of the community itself. The results of achieving SPM services for newborns have not yet reached 100%. The IMR (Infant Mortality Rate) of North Musi Rawas District is 8.7 per 1000 population, below the central government target of 16 per 1000 population. Conclusion: So that officers are given training so they can understand the background of program implementation, increase activities to increase targets, guide policies in carrying out program implementation, look for ways to overcome obstacles, and improve service outcomes for newborns. Keywords: Infant Mortality Rate, Programs, Maternal and Child Health

Enhancing Evidence-Based Practice in Rural Social Work: Applying the Theory of Planned Behavior to Identify Key Determinants.

This study explores the application and extent of utilization of Evidence-Based Practice (EBP) among rural social workers, identifying key factors such as attitudes, social pressures, and perceived barriers that influence its use. Utilizing the Theory of Planned Behavior as a framework, this research involved a comprehensive survey targeting rural social workers. The survey assessed their attitudes toward EBP, the social pressures, and the barriers in implementing EBP. Data from 91 participants were analyzed using multiple regression to determine how these factors impact EBP utilization. The analysis indicated that while attitudes toward EBP did not significantly affect its use, perceived ease of use, social pressures, and practical barriers were significant predictors. Interestingly, the data showed that external factors like organizational support and resource availability played a larger role than personal attitudes in the adoption of EBP. The regression model successfully explained 39% of the variance in EBP usage among rural social workers. The findings underscore the importance of external over internal factors in the adoption of EBP within rural settings. The study suggests that improving access to EBP resources and enhancing organizational support could facilitate more effective use of EBP among rural social workers. Effective implementation of EBP in rural areas necessitates addressing both perceived and actual barriers. Developing strategies to enhance resource availability and organizational support is recommended to boost EBP adoption, ultimately aiming to improve service outcomes and client well-being.

Activating Co-production of Rural Service Delivery: Examining the Role of Nonprofit Organizations Using a Case Study in China

Although co-production between the government and society can improve service outcomes, the two parties may lack the willingness and the capacity to cooperate. Can nonprofit organizations play an active role in facilitating government–citizen co-production? If so, how? The role of nonprofits in social services co-production has received increasing attention, but studies on developing countries are limited. Therefore, this study conducts an in-depth case study of a rural social work institute in Z village, Beijing, China. Using on-site observations, semi-structured interviews, and secondhand materials, we found that social workers adopted four strategies to engage community officials and rural residents in service co-production. They established trustworthy relationships, facilitated effective communication, fostered shared motivation, and built co-productive capacity. The results showed that nonprofit organizations use third-party roles and professional skills to shape government-citizen interactions through service co-production. These findings can improve rural service provision in developing countries.

Effective service provision and partnerships in service providers for children and young people with special educational needs and disabilities: a mixed methods systematic review protocol

It is widely recognized that provision of services for children and young people (CYP) with Special Educational Needs and Disabilities (SEND) are enhanced when services such as healthcare, social care, and education collaborate and interact effectively, rather than separately. In the UK, while there have been significant changes to policy and provision which support and improve collaboration, professionals responsible for implementing these changes face multiple challenges, including a lack of specific implementation guidance and a logic model or framework to illustrate how effective multi-agency working could, or should, work. This systematic review aims to identify the ‘key ingredients’ for effective multi-agency working in services for CYP with SEND; and the most effective forms of partnership working in this setting. In addition, the review will highlight interventions that lead to improved service outcomes; and the conditions in the local area (organisational or geographical) that support and encourage success. This protocol has been written following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Searches will be conducted on several health, care, education and applied social science databases from the year 2012 onwards. Citation chaining will be undertaken, as will broader grey literature searching to enrich the findings. Qualitative, quantitative, and mixed methods studies will be included, assessed independently and critically appraised or assessed for risk of bias using appropriate tools based on study design. Data will be extracted using a standardized, pre-piloted data extraction form. A convergent segregated approach to synthesis and integration will be used in which the quantitative and qualitative data will be synthesized independently, and then integrated using a joint display integration matrix. Results will be of interest to educators and health and social care professionals that provide services to those with SEND. These will also be used to develop policy recommendations for how UK healthcare, social care, and education services for CYP with SEND aged 0–25 can most effectively collaborate and improve service outcomes. The review will also identify any gaps in the literature to recommend areas for future research. Funding for this review was provided by the Department for Education.PROSPERO registration: CRD42022352194.

Blood, dose recommendation reports and phone calls: Experiences of a therapeutic drug monitoring advisory service for vancomycin.

Dose-prediction software is recommended to enable area under the curve over 24 h (AUC24 )-guided dosing of the antibiotic vancomycin. However, uncertainty remains about how best to implement software in the clinic. We describe the activity, over 18 months, of a consultative therapeutic drug monitoring Advisory Service (the Service) for vancomycin that used dose-prediction software alongside clinical expertise, identifying factors that influence attainment of therapeutic targets. Of the 408 vancomycin dose reports provided for 182 courses of therapy, most (57%) recommended a dose change. The majority (82.8%, 193/233) of recommended dose adjustments were accepted by treating teams. A dose report was not published for 125 courses of therapy, with reasons including patient in intensive care unit or service error. An estimated 26.6h of staff time was allocated to Service activities each month. Publication of a dose report facilitated attainment of therapeutic targets (P = .002). Software integration could improve Service outcomes, avoiding errors and reducing staff workload.

N29 Audit of Inflammatory Bowel Disease Telephone Advice Line

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic unpredictable condition of the gastrointestinal tract and advice lines for chronic disease are well established. Advice lines are a fundamental part of the Inflammatory Bowel Disease services. They offer advice and support for patients and have been shown that early intervention via an advice line can have a major impact in avoiding hospitalisation due to a flare up. Inflammatory Bowel Disease advice lines provide for multiple queries in relation to IBD and increasing demands were observed. The introduction and increased use of biologic medication (subcutaneous and oral) requires a repeat Hi Tech prescription and this has increased the workload through the IBD advice line. The aim was establish if aspects of the IBD advice line was in accordance with IBD Standards UK and to highlight any deficiencies that would require corrective action Methods Data was collected on all telephone calls received by the ANP IBD advice line during the data period 17/01/2022 to 11/02/2022 (n=80). The average number of monthly calls to the service is 146. Prospective data was collected by ANP IBD and analysed by the Clinical Audit Facilitator using IBM SPSS Statistics v 24. Criteria used to measure against: Rapid access to specialist advice should be available to patients to guide early flare intervention, including access to a telephone/email advice line with response by the end of the next working day ( IBD Standards UK) Results The highest number of calls to the advice line was 23/80 (29%) for a Hi Tech prescription. Flare up calls consisted of 21.2% of the calls and results investigations was equal to this. Administration queries and medication queries consisted of 7.5% of the calls. Clinical related queries were almost 9% of the calls. 59% of calls were returned within 36 hours. Mean interval of time call was returned was 34.7 hours and a median interval of 28 hours. Conclusion The audit indicates the highest number of calls are for repeat Hi tech prescriptions for medications. A Quality Improvement Plan includes the establishment of a dedicated Hi Tech Prescription Telephone/Virtual Clinic. This will also ensure an improved quality and a safer standard of care for patients. . The audit further identifies the number of calls and the effectiveness of the Inflammatory Bowel Disease advice line e.g. the number of calls (17/80) that dealt with a flare up that would have possibly attended the Emergency Department. It also highlights the time intervals for return of calls (33/80) calls were returned > 36 hours. A new Clinical Nurse Specialist Inflammatory Bowel Disease would improve service outcomes.

The Power of Identity Cues in Text-Based Customer Service: Evidence from Twitter

Text-based customer service is emerging as an important channel through which companies can assist customers. However, the use of few identity cues may cause customers to feel limited social presence and even suspect the human identity of agents, especially in the current age of advanced algorithms. Does such a lack of social presence affect service interactions? We studied this timely question by evaluating the impact of customers’ perceived social presence on service outcomes and customers’ attitudes toward agents. Our identification strategy hinged on Southwest Airlines’ sudden requirement to include a first name in response to service requests on Twitter, which enhanced customers’ perceived level of social presence. This change led customers to become more willing to engage and more likely to reach a resolution upon engagement. We further conducted a randomized experiment to understand the underlying mechanisms. We found that the effects were mainly driven by customers who were ex ante uncertain or suspicious about the human identity of agents, and the presence of identity cues improved service outcomes by enhancing customers’ perceived levels of trust and empathy. Additionally, we found no evidence of elevated verbal aggression from customers toward agents with identity cues, although a mechanism test revealed the moderating role of customers’ emotional states. Our study highlights the importance of social presence in text-based customer service and suggests a readily available and almost costless strategy for firms: signal humanization through identity cues.

Home-Tutoring Services Assisted with Technology: Investigating the Role of Artificial Intelligence Using a Randomized Field Experiment

Despite a rising interest in artificial intelligence (AI) technology, research in services marketing has not evaluated its role in helping firms learn about customers’ needs and increasing the adaptability of service employees. Therefore, the authors develop a conceptual framework and investigate whether and to what extent providing AI assistance to service employees improves service outcomes. The randomized controlled trial in the context of tutoring services shows that helping service employees (tutors) adapt to students’ learning needs by providing AI-generated diagnoses significantly improves service outcomes measured by academic performance. However, the authors find that some tutors may not utilize AI assistance (i.e., AI aversion), and factors associated with unforeseen barriers to usage (i.e., technology overload) can moderate its impact on outcomes. Interestingly, tutors who significantly contribute to the firm's revenue relied heavily on AI assistance but unexpectedly benefited little from AI in improving service outcomes. Given the wide applicability of AI assistance in a variety of services marketing contexts, the authors suggest that firms should consider the potential difficulties employees face in using the technology rather than encourage them to use it as it is.

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review.

Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.

Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services.

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

A Qualitative Study of Consumers’ Experiences of the Quality of Mental Health Services in Ghana

Integrating consumers’ experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers’ experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers’ subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers’ lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity.

Factors associated with the quality of mental health services and consumers'functionality using tertiary-based services.

Assess factors associated with the quality of mental health services. Cross-sectional design, quantitative data, and 510 consumers from three psychiatric facilities. The average age of consumers was 34 yearsand 51.57% males. Consumers reported mixed satisfaction with the quality of mental health services (mean = 3.2; SD = 0.56) but were dissatisfied with the range of interventions (mean = 1.57; SD = 0.77). Predisposing (age, education, and primary occupation), enabling (insurance status), and need factors (mental health status) were significantly associated with quality indicators (range of interventions, efficacy, and overall satisfaction). These factors were significantly associated with consumers' functionality (cognition, mobility, self-care, getting along, life activities, and participation). Policymakers and clinicians are encouraged to incorporate the predisposing, enabling, and need factors into mental health planning, monitoring, and advocacy to improve service outcomes.

Elder Abuse Identification by an Australian Health Service: A Five-Year, Social-Work Audit

ABSTRACT For hospitals and other health-care services, identifying older people experiencing abuse remains a challenge. Social workers at St Vincent’s Hospital Melbourne (SVHM) used a clinical data mining approach to retrospectively audit electronic medical records containing 466 episodes of care over a five-year period where elder abuse was identified based on a system of alerts. The findings highlight key characteristics of the vulnerable older persons, the perpetrators, their social contexts, and interventions undertaken, clarifying a range of vulnerability and risk factors in the sample. Half were aged 80 years and over; two thirds lived with the person of concern; two thirds were from culturally and linguistically diverse backgrounds, and a third had cognitive impairment. A high proportion were assessed as being at moderate to high levels of risk, requiring urgent to prompt intervention. Audit findings strengthened knowledge and led to improvements in elder abuse responses by social workers, which included policy development, training, risk management and safety planning processes, resourcing, and research initiatives. This paper describes how social workers engaged in data collection and analysis to inform their practice within a health-care setting and contributed to service evaluation and improvements. IMPLICATIONS This paper demonstrates how social workers can conceptualise and engage in research to better understand a social problem: in this case, it was responding to elder abuse, within a hospital setting. This paper highlights how social workers can use evidence from practitioner-driven research to inform practice and improve service outcomes for those they work with.

Seyahat Acentalarında Sürdürülebilirlik: Karadeniz Bölgesinde Faaliyet Gösteren Seyahat Acentaları Üzerine Bir İnceleme

The main purpose of the research is to determine the attitudes and behaviors of travel agencies towards sustainability activities. The data of the research was collected from the agencies operating in the Black Sea Region of Turkey. In this context, 250 valid survey data were collected and descriptive analysis, explanatory factor analysis, confirmatory factor analysis and mean value analyzes were performed. The results show that sustainability in travel agencies are realized in eight dimensions. These dimensions are named as follows: (i) improving service outcomes of agencies, (ii) cooperation with local stakeholders, and stakeholder selection (iii) ecological sensitivity in the production process of tour experience ecological sensitivity in the production of tour experience, (iv) relations with suppliers, (v) supplier preference, (vi) local cooperation and impact monitoring (vii) relationships with customers, (viii) supporting sustainability. However, it has been concluded that the most common dimension of agencies' practices within the scope of sustainability is relations with customers. Research is important in terms of determining attitudes and behaviours towards sustainability at the managerial level in the travel agencies, and its important in the context of pursuing the research in order to determine future planning and management strategies.

Service ecosystem well-being: conceptualization and implications for theory and practice

PurposeThis paper aims to conceptualize and characterize service ecosystems, addressing calls for research on this important and under-researched topic.Design/methodology/approachThe authors draw on four meta-theoretical foundations of S-D logic – resource integration, resource density, practices and institutions – providing a new integrated conceptual framework of ecosystem well-being. They then apply this conceptualization in the context of a complex healthcare setting, exploring the characteristics of ecosystem well-being at the meso level.FindingsThis study provides an integrated conceptual framework to explicate the nature and structure of well-being in a complex service ecosystem; identifies six key characteristics of ecosystem well-being; illustrates service ecosystem well-being in a specific healthcare context, zooming in on the meso level of the ecosystem and noting the importance of embedding a shared worldview; provides practical guidance for managers and policy makers about how to manage complex service ecosystems in their quest for improving service outcomes; and offers an insightful research agenda.Research limitations/implicationsThis research focuses on service ecosystems with an illustration in one healthcare context, suggesting additional studies that explore other industry contexts.Practical implicationsPractically, the study indicates the imperative for managing across mutually adapting levels of the ecosystem, identifying specific new practices that can improve service outcomes.Social implicationsExamining well-being in the context of a complex service ecosystem is critical for policymakers charged with difficult decisions about balancing the demands of different levels and actors in a systemic world.Originality/valueThe study is the first to conceptualize and characterize well-being in a service ecosystem, providing unique insights and identifying six specific characteristics of well-being.

Memorialization Practices Are Changing: An Industry Perspective on Improving Service Outcomes for the Bereaved.

Although considerable research efforts have focused on bereavement outcomes following loss, there are few studies which address the role of memorialization, particularly as it relates to formal service provision. Currently the funeral, cemetery, and crematorium industries are observing a steady decline in traditional and formal memorialization practices. This study aims to identify current memorialization practices and emerging trends, highlight key priorities for improving service outcomes for the bereaved, and understand the implications of changing consumer preferences for service provision. The study's qualitative research design incorporates two phases, a scoping literature review followed by in-depth interviews with eight service providers from the funeral, cemetery, and crematorium industries. A key finding is that the trend toward contemporary and informal memorialization practices blurs the lines between the role of consumers and service providers. There is a clear opportunity for service providers to engage in community education as a means of building supportive relationships with and improving service outcomes for the bereaved.

Empathy for service: benefits, unintended consequences, and future research agenda

PurposeEmpathy is a core characteristic of helping and caring interactions and thus is fundamental to service. Yet, to date, service marketing literature has focused on a restricted view of the value of empathy as it leads to improved service quality perceptions and successful sales outcomes. The aim of this paper is to provide a review of the empathy literature and the dispositional and situational factors affecting it, so as to further explore its potential benefits and limitations for service.Design/methodology/approachA summative review of the empathy literature uncovers cause–effect relationships and their potential boundary conditions. Theoretical propositions set an agenda for future research on empathy for service that breaks new ground.FindingsEmpathy can reduce anti-social, revenge, discrimination and unethical behaviors in service settings. It can also improve value-in-context experiences for users of service innovations. Notwithstanding its potential benefits, empathy can diminish the objectivity and performance of service providers when experienced at extreme levels. Empathy can also serve as an ingratiation influence tactic and can be detrimental to the target in embarrassing service contexts.Originality/valueThis paper suggests propositions for future research to advance theory and managerial practice on the use of empathy to improve service outcomes for interacting actors. It also alludes to the potential dark side of empathy when experienced at excessive levels or when used to manipulate.

Improvement attributes in healthcare: implications for integrated care

PurposeHealthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care.Design/methodology/approachThis study is based on an integrative literature review on systemic improvement in healthcare.FindingsA central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics.Practical implicationsAccommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process.Originality/valueShared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data

SummaryBackgroundInternationally, the clinical outcomes of routine mental health services are rarely recorded or reported; however, an exception is the English Improving Access to Psychological Therapies (IAPT) service, which delivers psychological therapies recommended by the National Institute for Health and Care Excellence for depression and anxiety disorders to more than 537 000 patients in the UK each year. A session-by-session outcome monitoring system ensures that IAPT obtains symptom scores before and after treatment for 98% of patients. Service outcomes can then be reported, along with contextual information, on public websites.MethodsWe used publicly available data to identify predictors of variability in clinical performance. Using β regression models, we analysed the outcome data released by National Health Service Digital and Public Health England for the 2014–15 financial year (April 1, 2014, to March 31, 2015) and developed a predictive model of reliable improvement and reliable recovery. We then tested whether these predictors were also associated with changes in service outcome between 2014–15 and 2015–16.FindingsFive service organisation features predicted clinical outcomes in 2014–15. Percentage of cases with a problem descriptor, number of treatment sessions, and percentage of referrals treated were positively associated with outcome. The time waited to start treatment and percentage of appointments missed were negatively associated with outcome. Additive odd ratios suggest that moving from the lowest to highest level on an organisational factor could improve service outcomes by 11–42%, dependent on the factor. Consistent with a causal model, most organisational factors also predicted between-year changes in outcome, together accounting for 33% of variance in reliable improvement and 22% for reliable recovery. Social deprivation was negatively associated with some outcomes, but the effect was partly mitigated by the organisational factors.InterpretationTraditionally, efforts to improve mental health outcomes have largely focused on the development of new and more effective treatments. Our analyses show that the way psychological therapy services are implemented could be similarly important. Mental health services elsewhere in the UK and in other countries might benefit from adopting IAPT's approach to recording and publicly reporting clinical outcomes.FundingWellcome Trust.