Team effectiveness and organizational context in the implementation of a clinical innovation.

OBJECTIVES: The study examined the relationship between care delivery team effectiveness, management support, organizational culture, and the extent of implementation of a clinical innovation.
METHODS: The study involved 6 target clinic areas in 78 Department of Veterans Affairs medical centers that participated in the national implementation of Advanced Clinic Access (ACA). Primary data were collected through staff surveys and structured interviews; secondary analyses were conducted using administrative databases. Hierarchical linear models were used to test the influence of team effectiveness and organizational context on implementation ratings. RESULTS AND
CONCLUSIONS: Team effectiveness as measured by team knowledge and skills was significantly associated with the extent of ACA implementation in both primary and specialty care. Team functioning was significant only in primary care. Management support as measured by personal leadership support for quality improvement and the importance of reduced wait times was also significantly associated with ACA implementation, but practical management support and organizational culture were not. Team effectiveness partially mediated the relationship between extent of implementation and personal leadership support. Findings support the underlying theory that implementation of clinical innovations depends on both individual staff and a more complex dynamic of individuals operating within work units in the larger organization.