Increasing Access to Organization Theories for Implementation Science

Abstract

BackgroundOrganization theories offer numerous existing, highly relevant, yet largely untapped explanations of the organizational dynamics underlying evidence-based intervention (EBI) implementation. Rooted in ideas regarding power, autonomy, and control, organization theories can explain how and why organizations adopt, implement, and sustain EBI use. Although they have gained visibility, organization theories remain underused in implementation research, perhaps due to their inaccessibility to implementation scientists. To improve access to organization theory among implementation scientists, we summarized organization theories with relevance to implementation science.MethodsLed by the Cancer Prevention and Control Research Network (CPCRN) Organization Theory for Implementation Science workgroup, we employed a modified Delphi process to reach a consensus among 18 experts at the intersection of organization and implementation science regarding organization theories with relevance to implementation science. From texts that described the organization theories, using standardized abstraction forms, two investigators independently abstracted information regarding constructs, propositions regarding how or why constructs might influence implementation, the potential relevance of organization theories' propositions for implementation, and overviews of each theory. The investigators then reconciled discrepancies until reaching consensus. A third investigator reviewed reconciled abstraction forms for accuracy, coherence, and completeness.FindingsWe identified nine organization theories with relevance to implementation science: contingency, complexity, institutional, network, organizational learning, resource dependence, sociotechnical, and transaction cost economics. From the theories, we abstracted 70 constructs and 65 propositions. An example proposition from institutional theory is: “Coercive, mimetic, and normative pressures contribute to organizations…within an organizational field [becoming increasingly similar].” These propositions can be operationalized as levers to facilitate EBI implementation.ConclusionsTo increase use in the field, organization theories must be made more accessible to implementation scientists. The abstraction forms developed in this study are now publicly available on the CPCRN website with the goal of increasing access to organization theories among an interdisciplinary audience of implementation scientists through the CPCRN Scholars program and other venues. Next steps include consolidating organization theory constructs into domains and translating the resulting framework for use among researchers, policymakers and practitioners, aiding them in accounting for a comprehensive set of organization theory constructs thought to influence EBI implementation.

Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers

“…We found centralization to be critical to developing the SCORE intervention in this context. This finding is consistent with arguments put forth by Birken, Leeman, and others that organizational theories, which explain interactions between organizations and their external context, can be used in planning for implementation [ 43 , 44 ]. Centralization may be particularly appropriate in contexts such as these rural CHCs, which have limited staff resources with which to deliver interventions with fidelity, limited control over external organizations, and low patient volume, resulting in high transaction costs and motivating the outsourcing of implementation activities to a centralized entity with dedicated and specialized resources, per transaction cost economics theory [ 45 ].…”

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

“…Distilling many constructs from several theories into a limited number of domains limits the burden on implementation scientists to account for the vast array of potentially important organizational influences on implementation. The six domains that we identified in this study reflect concepts that are central to organization theory, including power, structure, autonomy, control ( 20 ), but which are less commonly addressed in implementation science. The concepts reflected in the OTIS framework offer perspective on key questions in implementation science, such as how and why organizations adopt, implement, and sustain evidence-based practices—or resist doing so.…”

“…To identify conceptually distinct categories (domains) of constructs, we asked participants to sort virtual cards for each of the 70 constructs from nine organization theories relevant to implementation identified in previous work ( 20 ), accompanied by their definitions, into piles as they deemed appropriate. We then asked participants to name each pile.…”

“…Some of the data analyzed during this study have been previously published and are available from ( 20 ).…”

“…To equip implementation scientists with understanding of a broader scope of organization-level constructs and their hypothesized influence on implementation, a comprehensive yet accessible framework of organizational influences on implementation is needed. In this paper, we describe the development of the Organization Theory for Implementation Science (OTIS) framework, which summarizes constructs from nine organization theories identified as relevant to implementation in preliminary studies ( 20 ). Our overarching goal is to increase implementation scientists' familiarity with and conceptualization of the myriad organizational factors that influence implementation through mechanisms clearly articulated by organization theories.…”