The Organizational Context Strategy Structure And Culture Pdf

the organizational context strategy structure and culture pdf

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You can maintain full control over the organizational structure of your business and you can also exert a strong influence over the company culture.

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The Leader’s Guide to Corporate Culture

Metrics details. Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation.

English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included.

Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. The search generated citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. Six main organizational contextual features organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings.

We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change.

These features corresponded to the constructs in the Consolidated Framework for Implementation Research CFIR , which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices.

Future research should focus on how organizational features interact to influence implementation effectiveness. Peer Review reports. Despite major financial investments and advancements in knowledge generation for evidence-based practices EBPs , healthcare organizations encounter significant implementation failures or challenges [ 3 ]. EBP entails making decisions about how to provide or promote healthcare by integrating the best available research evidence with clinical expertise and patient values and preferences [ 4 ].

While provider-level characteristics such as knowledge, attitudes, and behavior about the EBP are widely acknowledged to be critical in addressing this know-do gap, organizational contextual features have also been recognized as a key consideration when implementing EBPs in healthcare settings [ 7 , 8 , 9 ]. Over the last decade, addressing this gap has been a priority research focus in implementation science.

One such focus has been the need to better understand the role organizational contextual features play in supporting or hindering implementation [ 10 , 11 ]. Quality improvement QI literature appears to establish parameters around this term. Glasgow et al. The authors described how the intrinsic organizational features such as staffing and culture, facility structure, and QI experience together make up the organizational context of a QI initiative.

The macro level recognizes the influence of political-economic forces, which focuses on interactions between markets and societies at the broadest level. The meso level represents organizational characteristics such as culture, climate, tacit rules, and shared meanings that influence individual behaviors [ 15 , 16 ]. The micro level consists of activities in the local setting that provide a contextual influence. Together, these levels of context form a complex set of influences on organizations [ 15 ].

The implementation theories, models, and frameworks appear to characterize context as a multi-dimensional concept that interacts with different phases of knowledge translation KT. While these implementation frameworks include context, no single framework is sufficiently comprehensive about what comprises context. In addition, the authors of the frameworks are often inconsistent in how context is theoretically and operationally defined. Without a shared understanding of context and its characteristics and features, there is little direction to which features of context are most influential to KT efforts [ 22 ].

Extending beyond conceptual theories, models, and frameworks; this review aims to synthesize and summarize organizational contextual features commonly reported to influence the implementation of EBPs in actual healthcare settings. The guiding question for the review was the following: Which organizational contextual features are most commonly reported to influence the implementation of EBP in healthcare settings?

Studies with diverse study designs and methods qualitative, quantitative, mixed methods that explored, described, or measured organizational contextual features in implementation research were included in this review [ 23 ].

Only empirical literature was included. The journal Implementation Science from journal inception to June was hand searched to uncover additional relevant articles. The search included four categories of search key terms: a Implementation, b Context, c Evidence, and d Organization. Citations missing an abstract during screening were retained for full-text screening to establish eligibility.

Citations meeting eligibility criteria were included for full-text screening. Full-text screening followed the same strategy as the title and abstract screening to ensure interrater reliability. Data extraction was performed by the same reviewers SAL, PEA for all included articles, independently and in duplicate. A third reviewer was available to resolve any disagreement between the two reviewers; however, all disagreements were resolved via consensus without involving a third reviewer.

For mixed methods studies, three components were appraised: qualitative, quantitative, and mixed methods component, with the overall score determined by the lowest component score. In keeping with integrative review methods [ 24 , 26 ], all records were retained in the analysis, regardless of score.

For each article, two reviewers assessed methodological quality independently and discrepancies were resolved via consensus. For each study, the steps of data reduction, data display, data comparison, and drawing conclusions and verifications were followed [ 24 ]. To ensure trustworthiness and rigor during data abstraction and synthesis, a table was developed to summarize the organizational contextual features.

The abstracted information was compared, and patterns of findings were recorded as they emerged, followed by groupings of similar data and the identification of several key themes [ 24 ].

Analysis followed a qualitative descriptive approach, given that most of the study designs were qualitative and the results from quantitative studies could not be aggregated due to heterogeneity in study design, outcomes, and type of intervention [ 27 ]. Inductive content analysis was used to uncover themes related to organizational context [ 28 , 29 ]. This analytic approach involved reading and rereading the articles to uncover any salient codes and categories, subsequently collapsing them into themes organizational contextual features [ 27 ].

The search yielded citations. Following a review of titles and abstracts, 46 relevant articles were retrieved in full text and reviewed for eligibility.

Thirty-six peer-reviewed journal articles were included in the integrative review. The studies were methodologically diverse; 11 Even though implementation success was frequently mentioned in the included studies, none defined implementation success. The studies were published between and and were based in 11 countries. At least participants were included in this review. Study participants comprised a wide range of stakeholders including physicians, nurses, and allied health professionals working as coordinators, medical staff, and senior managers from many different healthcare settings.

Six organizational contextual features included organizational culture; networks and communication; leadership; resources; evaluation, monitoring, and feedback; and champions. A series of sub-features included collaboration, teamwork, communication, financial resources, time, staffing and workload, and education and training. Organizational openness to trialing new innovations and a learning culture were highly associated with implementation success [ 30 , 31 , 32 , 33 , 34 , 35 ].

Conversely, an absence of a learning culture can act as a major hindrance to successful implementation [ 36 ]. Organizational cultures comprised of staff who have too much autonomy i. Sites demonstrating high implementation fidelity were marked by a strong culture of innovation, accompanied by positive staff attitudes and behavior toward the new initiative [ 40 ].

Three sub-features were commonly associated with implementation outcomes. Collaborative relationships that occur within and external to the organization were important for carrying out implementation plans. For instance, Barnett et al. First, materially based partnerships provided the organization with the resources required for the implementation and diffusion of new programs.

Harvey et al. Teamwork was characterized as good working relations, the ability to communicate clearly and effectively, and the capacity to solve problems together during EBP uptake [ 44 , 45 , 46 , 47 ]. Using an ethnographic case study design, McCullough et al.

However, when staff were dismissive of the evidence, strong teamwork served to reinforce resistance to implementation efforts. Teamwork was highly relevant in new programs that required participation from professionals in multidisciplinary teams. In a mental health organization where multidisciplinary staff peer specialists, practitioners were required to implement a new person-centered recovery program for their patients, poor multidisciplinary teamwork resulted in poor program uptake [ 38 ].

Communication greatly impacted the implementation of EBPs [ 37 , 39 , 44 , 46 , 48 , 49 , 50 ]. The establishment of systems and processes to more effectively manage information and communication about the change initiative influenced implementation success [ 39 ].

Communication between healthcare professionals in a Dutch intensive care unit ICU was an important barrier for a successful start of the implementation phase of a delirium scoring system [ 48 ]. Vamos et al. Leaders were often seen as providers of new knowledge and as key influencers in new implementation initiatives [ 44 ]. Leaders who created environments with high staff morale allowed staff to perceive themselves as part of the implementation team.

Transformational leadership often gave rise to clear roles and effective teamwork structures and cultivated a culture of learning [ 44 ]. Senior leaders were also essential for overall hospital staff involvement and buy-in [ 33 , 37 , 50 ]. The initial decision to begin an implementation effort within the hospital and the subsequent ongoing changes during the implementation process required the engagement of leadership at different levels and from multiple stakeholders across hospital departments [ 50 ].

The willingness of middle managers to partake in the implementation process was often contingent upon the support expressed by senior leaders [ 31 ]. The absence of senior leader support or tension between middle managers and their direct supervisors meant middle managers were significantly more reluctant to participate. Leaders work to optimize implementation success by expressing enthusiasm for the change; being present, supportive, and attentive to the implementation process; and demonstrating willingness to ask for feedback from staff regarding the change.

Leadership that is lacking in authority and unsupportive of change, or that neglects to hold staff accountable for the change, presents barriers to implementation [ 38 , 51 ]. Staff feel unmotivated to change when leaders were too controlling or unresponsive to requests for more training by staff who were required to implement the practice change [ 40 ].

This feature is divided into four sub-features that are interrelated and appear to work synergistically to hinder or promote the implementation process. Lack of sufficient dedicated funding among acute pain specialized teams meant they struggled to provide adequate service across different departments and sites, leaving no funding reserves for promoting and integrating new innovations.

Time that could have been allocated to activities like training and educating staff on the EBP was instead used for seeking funds for other initiatives [ 51 ].

Urquhart et al. Securing adequate funding to train and educate staff on the new initiative [ 37 , 38 , 39 , 53 ], allocating human resources to make the change [ 29 , 30 , 52 ], providing monitoring and feedback to ensure fidelity at the change sites [ 45 ], and ensuring a smooth transition for the implementation i. Staff experiencing heavy workloads or insufficient staffing on normal routine activities were less likely to carry out change [ 34 , 39 , 42 , 48 , 56 , 57 ].

Assigning dedicated staff to perform the change was associated with successful implementation.

2 The Organizational Context Strategy, Structure, and Culture

Metrics details. Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool.


Objectives Strategy Goals Programs Project Management: Achieving Competitive Advantage, Second Edition, by Jeffrey K. Pinto. Published by Prentice Hall.


The Difference Between Organizational Culture and Organizational Structure

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Organizational culture

WEEK 2-The Organization Context Strategy, Structure and Culture [Compatibility Mode]

The variable success of integrated care initiatives has led experts to recommend tailoring design and implementation to the organizational context. Yet, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. We thus lack knowledge of when and specifically how organizational contexts matter. To facilitate the accumulation of evidence, we developed a research toolkit for conducting case studies using standardized measures of the inter- organizational context for integrating care. We used a multi-method approach to develop the research toolkit: 1 development and validation of the Context and Capabilities for Integrating Care CCIC Framework, 2 identification, assessment, and selection of survey instruments, 3 development of document review methods, 4 development of interview guide resources, and 5 pilot testing of the document review guidelines, consolidated survey, and interview guide. The toolkit provides a framework and measurement tools that examine 18 organizational and inter-organizational factors that affect the implementation and success of integrated care initiatives.

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Quiz 2: The Organizational Context: Strategy,Structure,and Culture

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