Workforce Stability Research Articles

Addressing HLA Laboratory Vacancy Challenges: Insights from a Survey-Based Analysis

Abstract Introduction/Objective Laboratory vacancies pose significant challenges to institutions across diverse sectors. Understanding the landscape of these vacancies is crucial for developing effective strategies on how best to address them. The American Society of Histocompatibility & Immunogenetics (ASHI) Laboratory Professionals Recruitment Initiative (LPRI) was created to help address these issues by promoting and raising awareness of Histocompatibility and Immunogenetics (HLA) labs. This poster presents findings from a comprehensive survey conducted among various types of institutions to explore the prevailing dynamics surrounding HLA laboratory job vacancies. The primary purpose of this study is to provide a comprehensive overview of the HLA laboratory job vacancy landscape, including current vacancy rates, time taken to fill vacancies, and the perceived underlying causes attributed to these vacancies. Methods/Case Report The ASHI LPRI developed structured survey was administered to HLA laboratories represented in different service sectors, including hospital based, reference, organ procurement and independent laboratories. The survey collected data on the type of institution, current laboratory job vacancy rates, average time taken to fill vacancies, and perceived primary causes for vacancies. Data analysis was conducted to identify patterns and insights into the HLA laboratory vacancy challenges. Results (if a Case Study enter NA) The majority of respondents were from hospital-based or independent HLA laboratories, with few identifying as reference or organ procurement laboratories. Licensure or required certification was not a restricting factor in filling the vacancies. Vacancy rates for the varying institutions range between 10%- 25% with few reporting greater than 25% vacancy rate. A majority (54%) report their vacancies remain open for > 6 months. Predominant vacancy perpetuation was most attributed to lack of applicants (58%) and insufficient pay offered (41%). Conclusion The findings of this study offer valuable insights into the complexities surrounding laboratory job vacancies in the clinical HLA space. Understanding the underlying causes and dynamics of these vacancies is essential for developing targeted strategies to mitigate the problem. By addressing these challenges, institutions can enhance workforce stability and ensure optimal laboratory operations. This poster serves as a foundation for further research and policy interventions aimed at addressing laboratory vacancy challenges.

Investigating the Dynamics of Workforce Stability: The Influence of Perceived Employability on Career Resilience, Task Performance, Learning Agility and Employee Retention

The main purpose of this study is to analyze the complex interrelationships among perceived employability, employee task performance, employee retention, career resilience, and learning agility to cover this knowledge gap and provide HR practices and policies supported by evidence that can increase service sector development and contribute to Saudi Arabia's economic goals. The study used a cross-sectional quantitative design and conducted an online survey of employees in the service sector of Saudi Arabia. Snowball sampling was used during the data collection, and 403 usable responses were collected and utilized for data analysis. Data analysis techniques included descriptive statistics, Pearson correlation, and composite assessment analyses were conducted through SPSS 28. For hypothesis testing, the PLS-SEM model was used through SmartPLS4. R2adj, standardized root means square residual, Normed fit index, and Q2predict were used for model evaluation. The research findings highlighted the importance of perceived employability which is positively related to task performance and retention and show the need for organizations to train their employees so that they are characterized by career resilience and learning agility, which relate positively on their task performance and their retention within the Saudi service industry. Acquiring knowledge and understanding regarding these relationships is essential to develop targeted practices and policies to improve employee outcomes and elevate the organization's competitiveness in an economy undergoing rapid transformations. This study's findings provide practical implications regarding human resource management and organizational development strategies in Saudi Arabia that will support future research by enhancing perceived employability, building career resilience, developing employee task performance, improving learning agility, and ensuring a higher rate of employee retention, realizing the significance of each element in developing organizational goals and success. Keywords: perceived employability, employee task performance, employee retention, career resilience, learning agility.

The Influence of Workload and Work Environment on the Turnover Intention of Employees in PT. XYZ

This research aims to investigate the impact of workload and work environment on employee turnover intention at PT. XYZ. High turnover intentions can disrupt workforce stability and result in significant costs for the company. Two factors often associated with turnover intention are workload and work environment. Excessive workload can cause stress and fatigue, while an unsupportive work environment can reduce employee satisfaction and commitment. The study uses a quantitative approach, distributing questionnaires to 107 employees and sampling using the saturated sample method. Data analysis was conducted using SEM-PLS software. The hypothesis test tested the influence of workload and work environment on employee turnover intention. The results showed that workload variable (X1) is in the high category, work environment variable (X2) is in the bad category, and turnover intention (Y) is in the medium category. Quantitative data analysis with SEM-PLS showed that workload variables do not have a significant influence on turnover intention, while work environment variables have a significant influence. The research aims to evaluate company management's attention to workload and work environment conditions, with one variable showing a significant positive influence on employee turnover intention

Size isn't everything: Understanding the relationship between police workforce and crime problems

If and how policing affects crime has long been studied. On the relationship between police force size and crime, different authors come to different conclusions. This study examines the relationship between police resourcing, including workforce size, structure and stability over time using data for 42 police forces in the UK over a 13-year period.We construct two novel panel datasets. The first comprises measures of police workforce Size, Structure and Stability. The second provides measures of both crime frequency and crime severity. Issues of endogeneity make the modelling of the police-crime association complicated. Consequently, we analyse the data using a panel vector autoregression (PVAR) model which is capable of forecasting a temporal sequence of the interdependencies between police-crime relationships.Changes in total police personnel play an important role in reducing both crime frequency and severity, but the findings are more nuanced than this. Results highlight that the structure and stability of police organisations are important although these impacts are not always the same for crime volume and crime severity. We find that increases in frontline (non-sworn) support staff are associated with reductions in crime, while turnover rates of police staff are associated with increases in crime. In contrast, changes to the number of sworn police officers do not appear to be a good predictor of crime volume.The findings suggest that investment in frontline support staff and the development of strategies to retain skills and knowledge by reducing staff turnover may be efficient approaches for Police Forces to maximise the impact on crime of their workforce in resource-pressed policing settings. While previous research has found that police force size has a limited effect on crime, our findings indicate that more nuanced measurements of police resourcing are necessary to understand how police impact upon crime risk. The idea of police forces using basic officer-to-population ratios to make staffing decisions appears outdated and over-simplistic.

The Impact Of Job Characteristics On Employee Turnover Intention Through Psychological Contract In The Pharmaceutical Industry Of Pakistan

Introduction: The purpose of this research work is to examine the effect of job characteristics on intended turnover in the pharmaceutical industry of Pakistan with the ‘Psychological contract’ as a mediator amidst specialized knowledge that is pertinent to the sector’s growth. The characteristics included in this paper are autonomy, task identity, and skill variety, whereby studies were done to determine the effects of these characteristics on employee turnover intentions. Thus, the psychological contract acts as a pivotal link to breach, thereby increasing dissatisfaction and emergence of turnover. Objective: The study aims at establishing correlation between job content and turnover intention, Leader Member Exchange (LMX) as the moderator and psychological contract as mediator. Therefore, this research aims at filling this knowledge gap in relation to strategies of employee retention within the pharmaceutical industry of Pakistan and the way through which workforce stability could be boosted. Methods: The quantitative method was adopted, and based on the PLS-SEM technique to assess the hypothesis regarding the interaction[1] of job characteristics, psychological contract, LMX and turnover intention. The data were collected form 328 full time employees of pharmaceutical industries established in Pakistan. Recording of overall fit indices also supported these results. Results: The results show that among the job characteristics, autonomy was statistically significant and positive with β = 0. 058 and p < 0. 05 with corresponding tests showing significance for the-job skill variety (β = 0. 184, p < 0. 01) and feedback (β = 0. 166 p < 0. 01) to positively influence the psychological contract, thus translating to reduced turnover intention. LMX mitigates this relationship with high-quality LMX being particularly beneficial in enhancing the effect of the psychological contract on retention; (β = 0. 329, t < 0. 001). Conclusion: Consequently, the study shown that job characteristics should be encouraged and leader member relations should be promoted in order to minimize turnover intention in the context of Pakistan’s pharmaceutical industry. These findings are relevant to the organizational leaders who wish to enhance the retention rates of their employees and increase productivity through the effective job design and leadership practices. This is an important step in the validation of the model and has implications for the discussion on workforce stability within growing high demand sectors for application across the industries.

Clinician Wellbeing and Mental Health Assessment Across Two Acute Care Hospitals During the COVID-19 Pandemic.

The purposes of this study were to determine whether positive work environments affect clinician wellbeing and mental health, and to identify participants' priority interventions to improve clinician wellbeing. This study was designed to determine the potential benefit of modifying the aforementioned factors for clinicians and hospitals to impact positive patient outcomes. The SARS-CoV-2 virus pandemic has become one of the leading causes of death in the United States and worldwide, and has exacerbated widespread burnout among health care professionals. This has resulted in negative collateral implications for the stability of the clinician workforce. A Clinician Wellbeing study (CWS) was launched in two Magnet®-designated hospitals in the southeast. The CWS was part of a multi-site collaborative research project led by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing. A cross-sectional observational study design was implemented. Data were collected through anonymous surveys of 708 registered nurses (RNs) and advanced practice providers (APPs) working in two Magnet hospitals in the southeastern United States. Each participant completed 8 surveys. Clinicians' self-reported level of burnout was higher for both RNs and APPs at Emory University Hospital than Emory Saint Joseph's Hospital including intent to leave and dissatisfaction with their jobs. RNs and APPs self-reported their overall health to be good or excellent and they reported sleep quality as fair. Both groups in both hospitals indicated that they experienced anxiety, depression, and stress. The APPs reported a higher percent that their work did not leave enough time for personal and family life. Data also indicated that the primary work environment concern was related to inadequate nurse staffing. The data illuminated opportunities for the two hospitals to employ continuous improvement interventions to positively transform the work environment.

Elevating workforce stability: augmented reality and artificial intelligence solutions for overcoming employee turnover challenges in hospitality and tourism

Elevating workforce stability: augmented reality and artificial intelligence solutions for overcoming employee turnover challenges in hospitality and tourism

Executive Leadership Development of Corporate Healthcare Leaders: Integrating Spirituality into the Framework.

A faith-based healthcare system implemented a Leadership as Wholeness formation program, including a spiritual formation curriculum described here. The spiritual formation curriculum intends to connect leaders with their purpose and identity to ensure mission stability in the organizational culture, now and in the future. More research must be done to understand how, or even if, these types of programs make a meaningful difference in organizational mission initiatives and workforce stability.

ORGANIZATIONAL COMMITMENT OF JOB ORDER EMPLOYEES IN PHILHEALTH-CAR: INPUT TO STRATEGIC MANAGEMENT

Organizational commitment among Job Orders significantly influences workforce stability and performance in an institution like PhilHealth-CAR. This study investigates the levels of affective, continuance, and normative commitments among JOCs through a quantitative approach. The findings revealed the existence of moderate affective commitment, which is driven by a sense of belonging and a good culture at the workplace. Perceived costs drove the continuance commitment due to leaving, and normative commitment reflected ethical obligations and loyalty. These vary from improving the culture in an organization to having a stronger affective commitment to aligning leadership with the employees' values to enhance normative commitment.

State-Based Evaluation of the Workforce Pipeline from Paramedic Program Enrollment to Agency Affiliation

Objectives The strength and stability of the paramedic workforce is dependent on the continual flow of EMS clinicians into the field. Workforce entry requires three distinct steps: program completion, certification attainment, and affiliation with an EMS agency. At each of these steps, future EMS clinicians may be lost to the workforce but the contribution of each is unknown. Our objective was to evaluate these inflection points using a state-based registry of EMS clinicians from their point of entry into the EMS education system to eventual EMS agency affiliation. Methods This is a retrospective cohort evaluation of paramedic students in the Commonwealth of Virginia. We included any student who enrolled in a paramedic program in 2017 or 2018. Data were provided by the Virginia Office of Emergency Medical Services, who tracks the development of EMS clinicians from the point of entry into an educational program through their affiliation with an EMS agency upon employment. Our primary outcomes include proportions of enrolled students who complete a program, graduating students who attain national/state certification, and nationally certified EMS clinicians who affiliate with an EMS agency. Proportions were calculated at each step and compared to the overall population of students enrolled. Results In 2017 and 2018, 775 and 603 students were enrolled in paramedic programs, respectively. Approximately a quarter of students did not complete their paramedic program (2017: 25% [192/775]; 2018: 28% [170/603]). Of those who graduated, the proportion of students not gaining certification was lower (2017: 11% [62/583]; 2018: 17% [75/433]). Of those who certified, those not affiliating was similarly low (2017: 15% [77/521]; 2018: 13% [46/358]). Evaluating the effect of each of these steps on the total entry into the workforce, nearly half of those who originally enrolled did not join the workforce through agency affiliation (2017: 43% [331/775]; 2018: 48% [291/603]). Conclusions There are multiple areas to enhance retention of potential EMS trainees from program enrollment to EMS agency affiliation. This analysis suggests that educational attrition has a larger impact on the availability of new paramedics than certification examinations or agency affiliation decisions, though is limited to a singular state evaluation.

Nurse Burnout: A Critical Threat to U.S. Healthcare Workforce Stability

Nurse Burnout: A Critical Threat to U.S. Healthcare Workforce Stability

The influence of personal resources and job stress on turnover intention among employees in the ground transportation industry

This study investigates the impact of Personal Resources and Work Stress on Turnover Intention among employees in the intercity bus transportation industry, specifically drivers, assistants, and conductors. It employs a quantitative approach using Structural Equation Modeling Partial Least Squares (SEM PLS) to analyze the proposed hypotheses. The research sample comprises randomly selected employees from transportation companies in Surabaya, Madiun, Tulungagung, and Probolinggo, East Java, Indonesia.The analysis reveals significant relationships: Personal Resources significantly influence Work Stress (t=7.685, p=0.000), Personal Resources influence Turnover Intention negatively (t=-5.025, p=0.000), and Work Stress positively affects Turnover Intention (t=3.892, p=0.000). Additionally, Personal Resources indirectly influence Turnover Intention through Work Stress mediation (t=4.677, p=0.000). These findings underscore the crucial role of personal resources in managing work stress and reducing turnover intention in the intercity bus transportation sector. This research conclusion thighlights the strategic importance for companies to enhance employee personal resources to foster workforce stability and mitigate turnover intention effectively.

Unlocking Nurse Satisfaction Global Imperatives for Retention and Wellbeing

This study explores job satisfaction among nurses through a descriptive cross-sectional analysis conducted from January to April 2024, using a purposive sample of 400 participants. The findings reveal that while 85.9% of nurses are moderately satisfied with their jobs, satisfaction varies significantly between internal job elements (77.5% satisfaction) and external job factors (62.2% satisfaction). The study recommends the implementation of career development programs, recognition initiatives, and work-life balance strategies, alongside stress management and resilience training, to enhance overall job satisfaction and prevent burnout. These measures are crucial for improving healthcare outcomes and reducing staff turnover. Highlights: Moderate Satisfaction: Most nurses are moderately satisfied, highlighting areas for improvement. Satisfaction Disparity: There's a significant gap between satisfaction with internal and external job elements. Strategic Interventions: Career development and stress management programs are recommended to boost satisfaction and retention. Keywords: Nurse Satisfaction, Job Factors, Healthcare Management, Stress Prevention, Workforce Stability

Analysing Nurse Talent Management: A 6-Year Study Before and During COVID-19 Using the McKinsey 9-Box Matrix

Purpose – Talent management plays a pivotal role in shaping the quality and efficacy of health care organizations, with particular significance in nursing. Aims(s) – This research delves into the assessment of talent management for nurses, using the McKinsey 9-Box Matrix, both pre- and post COVID-19 pandemic. Design/methodology/approach – Employing a retrospective design spanning six years, this study encompasses 1319 nurses evaluated using the McKinsey 9-Box Matrix. This method involves performance and potential evaluations, incorporating face-to-face interviews with the Directorate of Nursing Services executive team. Findings – Significant variations in nurse positions, department distributions, and educational backgrounds were observed before and during the COVID-19 pandemic. Noteworthy shifts in McKinsey 9-Box Matrix assessments indicated pandemic-induced changes in nurse categorization. Approximately one-third of nurses were classified as B2: Core Working Group, which is crucial for workforce stability. Gender did not yield significant differences in the McKinsey 9-Box Matrix evaluations. Although variations were noted in categories A1, A2, and B1 before and during COVID-19, employment status did not significantly impact these assessments. Limitations of the study – Findings aweredrawn from a private health care group, potentially limiting generalizability to diverse settings, populations, or contexts. Practical implications – This study provides invaluable insights into the evolving land-scape of nursing during the pandemic. It illuminates shifts in education levels, posi-tions, departments, leadership potential, and specific evaluation categories among nurses. Originality/value – Contributing significantly to the existing literature, this study provides a nuanced analysis of talent management practices among nurses. The in-sights garnered offer a fresh perspective, informing health care organizations’ ‘talent management strategies, especially considering the evolving health care landscape shaped by the pandemic.

A Model for Occupational Pensions Privately Administered for Police and Military Personnel

Abstract In the context of legislation introduced in Romania through Law 1 of 2020 regarding occupational pensions, this paper presents an evaluation of occupational pension system for police and military personnel and takes into consideration privately administered funds that would complement the current system. The paper evaluates the impact of the complementary occupational pension system, focusing on its dual role as both a fiscal instrument for internal financing within Romania and a mechanism for enhancing social and economic security for retired police and military staff. The occupational pension system can diversify funding sources, potentially easing the national public debt burden, while offering a sustainable and adequate retirement income for service members. Furthermore, the analysis extends to the occupational pension system's efficacy in fostering workforce stability, particularly post-eligibility for military state pensions. The study addresses the system's potential influence on staff motivation and retention, underpinning its role in maintaining a robust and committed service workforce. This simulation-based study leverages international models and legislative frameworks to corroborate these benefits, providing a nuanced understanding of the occupational pension system’s role in the broader context of public service pensions.

Career adaptability among new oncology nurses: A longitudinal exploration.

This study aims to explore the longitudinal predictive effect of self-awareness on career adaptability in new nurses at a tumor specialty hospital and the mediating mechanisms of work readiness and transition shock. Career adaptability is crucial for the personal development of nurses and also intricately linked to the retention rates among newcomers in oncology nursing. Inadequate career adaptability contributes to higher turnover, which in turn exacerbates the shortage of qualified nursing personnel in this field. There is a pressing need for dedicated research and interventions that support new nurses, especially in specialized areas like oncology, to promote their well-being and career advancement. Comprehending these challenges is essential for devising effective strategies that will retain nursing talent and ensure the sustainability of a robust healthcare workforce. Longitudinal data from four follow-up surveys were collected from 248 new clinical nurses at the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Mediation analyses using R 4.1.2 were conducted to examine the pathways between self-awareness, work readiness, transition shock, and career adaptability. Self-awareness not only directly predicts career adaptability but also influences it through the bidirectional and chained mediating pathways of work readiness and transition shock. These findings equip nursing managers with flexible strategies to foster and enhance nurses' career adaptability, providing targeted support as nurses assimilate into their clinical roles. This not only strengthens workforce stability but also mitigates turnover, ultimately reinforcing the healthcare workforce.

Impact of Relational Coordination on Job Satisfaction and Willingness to Stay: A Cross-Sectional Survey of Healthcare Professionals in South Tyrol, Italy.

Job satisfaction and willingness to stay are critical for workforce stability in a challenging healthcare environment. This study examined how relational coordination, a key factor in teamwork and communication, influences outcomes among healthcare professionals in a bilingual, culturally mixed region of Italy. This cross-sectional survey included general practitioners, hospital physicians, nurses, and administrators from the South Tyrol Health Service, using the 'Relational Coordination Survey' and additional measures of job satisfaction and willingness to stay. The analytical methods used included descriptive statistics, correlations, and regression analyses. This study applied path analysis, including mediation and moderation techniques, to investigate the roles of relational coordination and job satisfaction in influencing the willingness to stay. It employs Conditional Process Analysis with the PROCESS macro in SPSS, focusing on models for moderated mediation analysis. The results indicated a critical influence of relational coordination on both job satisfaction and willingness to stay among the 525 healthcare professionals. Job satisfaction varied by health district and years of service, with midcareer professionals being the least satisfied. The findings highlight the central role of relational coordination in job satisfaction and willingness to stay and confirm that low job satisfaction increases turnover intentions. Relational coordination directly enhanced job satisfaction and willingness to stay, while also serving as a mediating factor that amplifies the impact of job satisfaction on retention intentions. This study reinforces the need for strong teamwork and communication to stabilize the healthcare workforce. Targeted interventions aimed at improving relational coordination could significantly enhance job satisfaction and retention among healthcare professionals, particularly in culturally diverse settings such as South Tyrol.

Relationship between staff and quality of care in care homes: StaRQ mixed methods study.

Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence. To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers. Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model. English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings. Managers, residents, families and care home staff. Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged. Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes. Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes. This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

What do child protection social workers consider to be the systemic factors driving workforce instability within the English child protection system, and what are the implications for the UK Government’s reform strategy?

ABSTRACT In 2023, the UK Government published its long-awaited reform strategy for England’s children’s social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular ‘priority’ was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England’s child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media.

Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System.

Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.