1014 — Evaluating Organizational Context and Readiness for Change: EQUIP Results at Eight VA Medical Centers

Cohen AN (CoE-Sepulveda), Young AS (CoE-Sepulveda), Hamilton A (VISN22 MIRECC), Chinman M (VISN4 MIRECC), EQUIP-2 Co-Investigators (VISNs 3, 16, 17, 22)

Objectives:
The President’s New Freedom Commission revealed the pervasive problems in the mental health system and VHA responded with the Comprehensive Mental Health Strategic Plan and Uniform Services Package. There have been efforts nationally to implement mental health care that is recovery-oriented and evidence-based, but implementation has been challenging. To assist managers and policymakers make a successful plan for roll-out and uptake, VA needs to understand the organizational context and likely barriers. Data from the VA HSR&D QUERI study EQUIP-2 (Enhancing QUality of care In Psychosis) provides this information at 8 VAs across 4 VISNs.

Methods:
In EQUIP-2, each VISN selected 2 of 5 evidence-based practices for care improvement for veterans with schizophrenia; all chose increasing competitive employment and reducing weight. The project began with a context analysis of the care line using interviews and the TCU Organizational Readiness for Change Scale with both administrators and clinicians. Qualitative field notes maintain detailed information about readiness, recovery transformation efforts, and QI.

Results:
Examination of a partial dataset (28 administrators and 120 clinicians across 8 sites) identified differences in organizational readiness for change. Data indicate administrators perceive high needs for clinician training ( > 75th percentile); clinicians see this as the lowest of all needs (25th percentile). Administrators rated pressure to change as high ( > 75th percentile); clinicians acknowledged moderate pressure to change (mean). Administrators have a moderate sense of the clinic mission (mean); clinicians were comparatively unclear (below mean). Administrators rated the care line’s openness to change as high (75th percentile); clinicians perceived a lack of openness (25th percentile). Administrators perceived very good communication networks and interactions between themselves and clinicians (75th percentile); clinicians rated these channels as inadequate (below mean). These findings are supported by qualitative data.

Implications:
VAs vary widely in their readiness to engage in QI efforts. Organizational evaluation of sites can shape training, implementation, and communication efforts to meet each site’s needs and state of readiness, thereby increasing the likelihood that system redesign and quality improvement efforts are successful.

Impacts:
Results have informed roll-out of EQUIP-2, including targeted educational and marketing campaigns, monthly calls, and quality team meetings that include both administrators and clinicians at each site.