Contracting as a bridging factor linking outer and inner contexts during EBP implementation and sustainment: a prospective study across multiple U.S. public sector service systems

Abstract

Background Bridging factors are relational ties (e.g. partnerships), formal arrangements (e.g. contracts or polices) and processes (e.g. data sharing agreements) linking outer and inner contexts and are a recent evolution of the Exploration-Preparation-Implementation-Sustainment (EPIS) framework. Bridging factor research can elucidate ways that service systems may influence and/or be influenced by organizations providing health services. This study used the EPIS framework and open systems and resource dependence theoretical approaches to examine contracting arrangements in U.S. public sector systems. Contracting arrangements function as bridging factors through which systems communicate, interact, and exchange resources with the organizations operating within them. Methods The sample included 17 community-based organizations in eight service systems. Longitudinal data is derived from 113 contract documents and 88 qualitative interviews and focus groups involving system and organizational stakeholders. Analyses consisted of a document review using content analysis and focused coding of transcripts from the interviews and focus groups. A multiple case study analysis was conducted to identify patterns across service systems and organizations. The dataset represented service systems that had sustained the same EBP for between 2 and 10 years, which allowed for observation of bridging factors and outer-inner context interactions over time. Results Service systems and organizations influenced each other in a number of ways through contracting arrangements. Service systems influenced organizations when contracting arrangements resulted in changes to organizational functioning, required organizational responses to insufficient funding, and altered interorganizational network relationships. Organizations influenced service systems when contract arrangements prompted organization-driven contract negotiation/tailoring, changes to system-level processes, and interorganizational collaboration. Service systems and organizations were dependent on each other as implementation progressed. Resources beyond funding emerged, including adequate numbers of eligible clients, expertise in the evidence-based practice, and training and coaching capacity. Conclusion This study advances implementation science by expanding the range and definition of bridging factors and illustrating specific bi-directional influences between outer context service systems and inner context organizations. This study also identifies bi-directional dependencies over the course of implementation and sustainment. An analysis of influence, dependencies, and resources exchanged through bridging factors has direct implications for selecting and tailoring implementation strategies, especially those that require system-level coordination and change.

A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework

“…Bridging this gap requires a systematic assessment of the barriers that exist at multiple levels of healthcare delivery including the patient level, the provider level and the organisational level, and an associated plan for overcoming these barriers [7]. Bridging factors can be identified that work between system and organisational levels or interorganisational networks [8]. This would provide valuable information for clinicians and treatment services designed to ultimately address the pervasive harms associated with drug and alcohol use disorders.…”

Sustainability planning in the US response to the opioid crisis: An examination using expert and text mining approaches

“…This is because we were not able to locate accurate administrative or other data to reflect states’ recent organizational structures and functioning similar to that used to predict local government information sharing [ 58 ]. For future research in discriminating successful versus unsuccessful sustainment, it would be useful to include measures of inter-governmental organizational data as well as bridging data reflecting the relationships between providers and their outer contexts [ 59 , 60 ]. We expect such information would be useful not only for research but have practical value as well.…”

Forms and functions of bridging factors: specifying the dynamic links between outer and inner contexts during implementation and sustainment

“…Bridging factors are the connective tissue between system parts and may be broadly organized as relational ties, formal arrangements, and processes [ 12 ]. Bridging factors may be relational ties, such as a partnership between a government agency and community-based organizations, or an EBP intermediary that facilitates intervention adaptation and training with system and organizational leaders [ 5 , 12 ]. They may also be formal arrangements, including contracts between public sector agencies and local nonprofits, or a policy that provides a fiscal incentive for EBP use and facilitates EBP integration [ 12 ].…”

“…Bridging factors may be relational ties, such as a partnership between a government agency and community-based organizations, or an EBP intermediary that facilitates intervention adaptation and training with system and organizational leaders [ 5 , 12 ]. They may also be formal arrangements, including contracts between public sector agencies and local nonprofits, or a policy that provides a fiscal incentive for EBP use and facilitates EBP integration [ 12 ]. Other bridging factors may be process-oriented, such as data sharing procedures between state and local entities or accreditation, which links program developers with implementing organizations [ 12 ].…”

“…They may also be formal arrangements, including contracts between public sector agencies and local nonprofits, or a policy that provides a fiscal incentive for EBP use and facilitates EBP integration [ 12 ]. Other bridging factors may be process-oriented, such as data sharing procedures between state and local entities or accreditation, which links program developers with implementing organizations [ 12 ].…”