Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice

Abstract

The organizational social context in which mental health services are provided is believed to affect the adoption and implementation of evidence-based practices (EBPs) as well as the quality and outcomes of the services. A fully developed science of implementation effectiveness requires conceptual models that include organizational social context and tools for assessing social context that have been tested in a broad cross-section of mental health systems. This paper describes the role of organizational social context in services and implementation research and evaluates a comprehensive contextual measure, labeled Organizational Social Context (OSC), designed to assess the key latent constructs of culture, climate and work attitudes. The psychometric properties of the OSC measure were assessed in a nationwide study of 1,154 clinicians in 100 mental health clinics with a second-order confirmatory factor analysis of clinician responses, estimates of scale reliabilities, and indices of within-clinic agreement and between-clinic differences among clinicians. Finally, the paper illustrates the use of nationwide norms in describing the OSC profiles of individual mental health clinics and examines the cross-level association of organizational-level culture and climate with clinician-level work attitudes.

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…While understanding healthcare administrative and organizational factors is critical to the implementation of integrated behavioral medicine and specialist care, incorporating patient variables, such as the factors that enable access to care and resources, is particularly relevant when implementation is planned for vulnerable populations, such as underserved urban and rural poor [19,[23][24][25][26][27][28]. Both urban and rural poor experience unique access to care difficulties, including geographic barriers or financial limitations, that may influence health outcomes even when integrated behavioral medicine and specialty care are successfully implemented to others [29].…”

Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment

“…Relevant work in implementation science focused on classification might seek to place units into meaningful groups. As an implementation example, Glisson and colleagues [37] have created a profile system, the Organizational Social Climate (OSC) instrument, to characterize the organizational climate of mental health service organizations. Such classification activities can also facilitate ORIGINAL RESEARCH probability-based prediction studies.…”

“…Such classification activities can also facilitate ORIGINAL RESEARCH probability-based prediction studies. For instance, Glisson and colleagues [37] found that agencies with more positive OSC profiles sustain new practices for longer than agencies with less favorable organizational climates. Research designs intended to evaluate interunit differences may use instruments with established norms to make nomothetic comparisons between providers or agencies exposed to different implementation approaches [38,39] or to collect and compare benchmarking data from one implementation site against randomized controlled trial data [40].…”

The Costs of Implementing Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

“…These precursors are often referred to in the organizational change literature as elements of "organizational readiness" (Aarons, Hurlburt, and Horwitz, 2011;Aarons, Sommerfeld, and Walrath-Greene, 2009;Amatayakul, 2005;Cassidy, 1994;Damschroder et al, 2009;Greenhalgh et al, 2004;Hardison, 1998;O'Connor and Fiol, 2006;Weiner, Amick, and Lee, 2008). Although definitions of organizational readiness vary widely, they have in common several key constructs, such as whether an organization's culture and climate are ready to make general changes (for example, organizations with stronger staff morale, less staff turnover, and openness to new practices in general are more likely to support implementation of new practices) (Aarons, 2004;Glisson et al, 2008;Lehman, Greener, and Simpson, 2002), whether individual members view their organization as capable of change, or whether individual members are themselves prepared and willing to make a specific change or adopt a specific new practice (Lehman, Greener, and Simpson, 2002;Scaccia et al, 2015;Weiner, Amick, and Lee, 2008). Strategies for achieving organizational readiness include planning for change, educating staff, and restructuring service delivery systems .…”