Influence of Participation in a Quality Improvement Collaborative on Staff Perceptions of Organizational Sustainability

Abstract

Background: Organizational sustainability capacity (SC) – the ability to implement and maintain change – is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Dissemination and implementation research has generally not explored temporal changes in staff SC perceptions, and how quality improvement collaborative (QIC) participation influences those changes. This project addresses the gap, using the British National Health Services sustainability index, to measure staff SC perceptions at four time points (baseline and every 9 months) for participating clinics in the NIATx200 QIC initiative.Methods: Respondent demographic information (Organization ID, Job Function, First Initial, Day of Birth, Employment Status) allowed matching individual survey responses, so all analyses comprise responses from the same staff members (n=908, representing 2,329 total cases) across the evaluation timeframe. A mixed linear model repeated measures analysis fit three separate statistical models to assess potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours (Model III).Findings: Model I yielded strong overall predictive significance for Time (F=7.270, p<.0001), with staff perceptions of overall SC increasing throughout most of the study (t 1,4 =-6.74, p<.0001; t 2,4 =-3.100, p<.036; t 3,4 =-0.23, p=ns). Model II did not change the overall Time effect from Model I, but the assigned NIATx200 intervention – combined services, (t=-3.28, p=.026), staff job function and organizational administrators, (t=-3.50, p=.001) became significantly associated with greater perceptions of SC. The addition of participation levels in Model III demonstrated the importance of a higher participation dose (t=-3.73, p<.0001) on staff perceptions about overall SC.Implications for D&I Research: Although there was minimal staff exposure to sustainability principals within NIATx200, staff perceptions about their organization’s SC significantly differed over time. However, an organization’s participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.Trial Registration: ClinicalTrials.gov, NCT00934141 Registered July 6, 2009. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT00934141