Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: a hurdle regression analysis

Abstract

BackgroundMany state Medicaid programs are implementing pharmacist-led medication management programs to improve outcomes for high-risk beneficiaries. There are a limited number of studies examining implementation of these programs, making it difficult to assess why program outcomes might vary across organizations. To address this, we tested the applicability of the organizational theory of innovation implementation effectiveness to examine implementation of a community pharmacy Medicaid medication management program.MethodsWe used a hurdle regression model to examine whether organizational determinants, such as implementation climate and innovation-values fit, were associated with effective implementation. We defined effective implementation in two ways: implementation versus non-implementation and program reach (i.e., the proportion of the target population that received the intervention). Data sources included an implementation survey administered to participating community pharmacies and administrative data.ResultsThe findings suggest that implementation climate is positively and significantly associated with implementation versus non-implementation (AME = 2.65, p < 0.001) and with program reach (AME = 5.05, p = 0.001). Similarly, the results suggest that innovation-values fit is positively and significantly associated with implementation (AME = 2.17, p = 0.037) and program reach (AME = 11.79, p < 0.001). Some structural characteristics, such as having a clinical pharmacist on staff, were significant predictors of implementation and program reach whereas other characteristics, such as pharmacy type or prescription volume, were not.ConclusionsOur study supported the use of the organizational theory of innovation implementation effectiveness to identify organizational determinants that are associated with effective implementation (e.g., implementation climate and innovation-values fit). Unlike broader environmental factors or structural characteristics (e.g., pharmacy type), implementation climate and innovation-values fit are modifiable factors and can be targeted through intervention—a finding that is important for community pharmacy practice. Additional research is needed to determine what implementation strategies can be used by community pharmacy leaders and practitioners to develop a positive implementation climate and innovation-values fit for medication management programs.

Evaluating the implementation of an early supported discharge (ESD) program for stroke survivors: A mixed methods longitudinal case study

“…ESD was also perceived to align strongly with personal and organisational values, particularly in regards to client centred care and equity. While the CFIR includes the impact of values on implementation as part of 'other personal attributes', other implementation models (such as the organisational theory of innovation [30]) foreground the fit between an innovation and values more strongly. Externally to the organisation, the release of revised National Clinical Guidelines for Stroke Management [1] halfway through this trial also reinforced the quality of evidence supporting ESD and reconfirmed for participants they were adopting best practice.…”

Elucidating the influence of supervisors’ roles on implementation climate

“…Implementation climate is an organizational or group-level construct that reflects three domains—the degree to which professionals share the belief that a specific innovation is (1) expected, (2) supported, and (3) rewarded [3]. Implementation climate is a strong predictor of an organization’s consistent and quality use of an innovation [1, 2, 12, 13]. Unlike the organizational climate (which references general perceptions of the work environment), implementation climate strategically focuses on the context for a specific intervention.…”

Implementation and Effectiveness of an Interprofessional Support Program for Patients with Type 2 Diabetes in Swiss Primary Care: A Study Protocol

“…Using implementation science is crucial to assess the influencing factors for implementation projects and an effective innovation can fail to be implemented if strategies are not appropriate to the setting [ 36 ]. Implementation science shows that for behavioral change, strategies are required across multiple stages and levels [ 56 , 57 , 58 , 59 ]. In this research project, implementation strategies proposed were developed based on evidence from previous research projects [ 32 , 36 , 39 ].…”