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). |