Abstract
Background: External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings.
Methods: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion.
Results: Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes.
Conclusions: Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.
Document Type
Article
Publication Date
1-25-2018
Digital Object Identifier (DOI)
https://doi.org/10.1186/s12913-018-2856-9
Funding Information
This study was funded by National Institute of Drug Abuse (NIDA).
Repository Citation
Alagoz, Esra; Chih, Ming-Yuan; Hitchcock, Mary; Brown, Randall; and Quanbeck, Andrew, "The Use of External Change Agents to Promote Quality Improvement and Organizational Change in Healthcare Organizations: A Systematic Review" (2018). Health and Clinical Sciences Faculty Publications. 8.
https://uknowledge.uky.edu/clinicalsci_facpub/8
Included in
Health Services Administration Commons, Health Services Research Commons, Medical Specialties Commons
Notes/Citation Information
Published in BMC Health Services Research, v. 18, 42, p. 1-13.
© The Author(s). 2018
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.