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Table 3 Determinants of organizational change assessed by the diagnostic evaluation

From: A process for developing an implementation intervention: QUERI Series

Categories of behavior determinants Examples of specific factors
Characteristics of the external environment Federal/State regulations, policies, and payment systems. Location (e.g., rural, urban, or geographic or administrative region).
Organizational characteristics Financial features (e.g., fiscal structure, economic rewards/disincentives). Internal physical environment. Formal organizational features (e.g., staffing; reporting relationships; policies, regulations, rules, and procedures; scope of services; size). Informal organizational features (e.g., culture, norms, social influences, social networks, level of stress, level of burnout, staff tensions).
Characteristics of the clinical practice Mechanisms for follow-up, referral, and outreach (e.g., support for practice outcomes like continuity, coordination, and access). Mechanisms for enhancing prevention practices. Mechanisms for enhancing disease management practices. Information management mechanisms.
Characteristics of the individual provider Demographics (e.g., age, sex, ethnicity, recovery status). Education, credentials, (e.g., educational degrees, certification). Ongoing educational experiences (e.g., conferences, lectures, mentored or supervised practice, journal/guideline reading). Knowledge of depressive symptoms/assessment tools/treatments. Skills or competencies (e.g., technical and humanistic). Attitudes, beliefs, potential biases against pharmacotherapy for depression, psychological traits, cognitive processes, readiness to change.
Characteristics of patients Demographics (age, sex, education, income, employment, ethnicity). Payment mechanisms (e.g., insurance). Severity of substance abuse problems/polysubstance abuse. Extent and severity of comorbid depression/other psychiatric problems. Culture, beliefs, participation, cognitive processes, readiness to take medical advice. Knowledge, skills, information access. Expectations, preferences, adherence. Health and social functioning.
Characteristics of the encounter Location Type of visit (e.g., scheduled vs. unscheduled). Clinician/patient dyad characteristics (e.g., ethnicity match, sex match).
  1. Note: Modified from Rubenstein et al. [40]