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Implement Sci. 2017 May 12;12(1):62. doi: 10.1186/s13012-017-0592-x.

Organizational theory for dissemination and implementation research.

Author information

1
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. birken@unc.edu.
2
College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, USA.
3
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
4
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1107C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
5
Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, 401 Rosenau Hall, Campus Box 7445, Chapel Hill, NC, 27599-7445, USA.
6
Department of Family Medicine, University of Calgary, 8th Floor, Sheldon M. Chumir Health Centre, 1213 - 4 Street SW, Calgary, Alberta, T2R 0X7, Canada.
7
School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302-3995, USA.
8
National SafeCare Training and Research Center, Mark Chaffin Center for Healthy Development, PO Box 3995, Atlanta, GA, 30302-3995, USA.
9
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1104F McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
10
Department of Global Health, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
11
Department of Health Services, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.

Abstract

BACKGROUND:

Even under optimal internal organizational conditions, implementation can be undermined by changes in organizations' external environments, such as fluctuations in funding, adjustments in contracting practices, new technology, new legislation, changes in clinical practice guidelines and recommendations, or other environmental shifts. Internal organizational conditions are increasingly reflected in implementation frameworks, but nuanced explanations of how organizations' external environments influence implementation success are lacking in implementation research. Organizational theories offer implementation researchers a host of existing, highly relevant, and heretofore largely untapped explanations of the complex interaction between organizations and their environment. In this paper, we demonstrate the utility of organizational theories for implementation research.

DISCUSSION:

We applied four well-known organizational theories (institutional theory, transaction cost economics, contingency theories, and resource dependency theory) to published descriptions of efforts to implement SafeCare, an evidence-based practice for preventing child abuse and neglect. Transaction cost economics theory explained how frequent, uncertain processes for contracting for SafeCare may have generated inefficiencies and thus compromised implementation among private child welfare organizations. Institutional theory explained how child welfare systems may have been motivated to implement SafeCare because doing so aligned with expectations of key stakeholders within child welfare systems' professional communities. Contingency theories explained how efforts such as interagency collaborative teams promoted SafeCare implementation by facilitating adaptation to child welfare agencies' internal and external contexts. Resource dependency theory (RDT) explained how interagency relationships, supported by contracts, memoranda of understanding, and negotiations, facilitated SafeCare implementation by balancing autonomy and dependence on funding agencies and SafeCare developers. In addition to the retrospective application of organizational theories demonstrated above, we advocate for the proactive use of organizational theories to design implementation research. For example, implementation strategies should be selected to minimize transaction costs, promote and maintain congruence between organizations' dynamic internal and external contexts over time, and simultaneously attend to organizations' financial needs while preserving their autonomy. We describe implications of applying organizational theory in implementation research for implementation strategies, the evaluation of implementation efforts, measurement, research design, theory, and practice. We also offer guidance to implementation researchers for applying organizational theory.

KEYWORDS:

Adoption; External environment; Implementation; Organizational theory; Sustainment

PMID:
28499408
PMCID:
PMC5427584
DOI:
10.1186/s13012-017-0592-x
[Indexed for MEDLINE]
Free PMC Article

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