4.B.1
Organizations and systems: changing the setting, not only the people
Énoncé de compétence 4.B.1 d’ASPPB : Apply knowledge of organizations and systems to optimize delivery of psychological services
Psychological services are delivered inside organizations, and their structure, climate and outside pressures often decide whether a service works. A consultant who understands systems looks at how parts interact, involves the people who will carry out a change and targets organizational conditions as well as individuals. Research on burnout, organizational climate and implementation supports this wider view.
Notions clés
- Systems thinking
- An organization is a set of interacting parts, so a problem seen in one unit often comes from workflow, policy or incentives elsewhere, and a change in one part ripples through others.
- Climate and culture
- Organizational climate is how staff experience their work environment; culture is the shared norms and expectations. In a randomized trial, an intervention that improved organizational social context improved youth outcomes in community mental health programs.
- Inner and outer setting
- The updated Consolidated Framework for Implementation Research groups influences on a new practice into the innovation, the outer setting, the inner setting, the individuals involved and the implementation process.
- Organization-directed change
- In a meta-analysis of interventions for physician burnout, organization-directed interventions showed larger effects than physician-directed ones, supporting the view that burnout belongs to the whole organization.
- Participation in change
- People who help diagnose a problem and plan the change are more likely to carry it out. Process consultation and survey feedback rest on this principle.
Exemple commenté
A university counseling center asks a consulting psychologist how to cut a waiting list that grows every fall. The director's first idea is to ask clinicians to see more clients each day.
- Map the system from first contact to discharge: how intake works, how long clients stay, where referrals go and what campus policies send students to the center.
- Look at the outer setting as well, such as a faculty rule that a student needs a counseling letter for a late withdrawal, which adds visits that need not be therapy.
- Bring clinicians and front desk staff into the diagnosis, since they see where the flow stalls and will carry out any change.
- Pilot one change at a time, such as a same-day brief consultation slot, and track wait times and clinician workload before scaling up.
Diagnose how the organization produces the problem before asking individuals to work harder.
Vérifiez vos acquis
A community mental health agency trains its clinicians in a new trauma treatment, but few use it. Interviews point to full caseloads and no time set aside to prepare sessions. In the updated Consolidated Framework for Implementation Research, these barriers fall mainly in which domain?
Sources
- Panagioti, Panagopoulou, Bower, Lewith, Kontopantelis, Chew-Graham, Dawson, van Marwijk, Geraghty and Esmail (2017), Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis, JAMA Internal Medicine, 177(2), 195-205 (PMID 27918798), Abstract: organization-directed interventions SMD -0.45 against physician-directed SMD -0.18; burnout as a problem of the whole organization
- Glisson, Hemmelgarn, Green and Williams (2013), Randomized trial of the Availability, Responsiveness and Continuity (ARC) organizational intervention for improving youth outcomes in community mental health programs, Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 493-500 (PMID 23622850), Abstract: youth outcomes better in ARC programs and best where organizational social context improved most
- Damschroder, Reardon, Widerquist and Lowery (2022), The updated Consolidated Framework for Implementation Research based on user feedback, Implementation Science, 17(1), 75 (PMID 36309746), Additional file and text (PMC9617234): domains I Innovation, II Outer Setting, III Inner Setting, IV Individuals, V Implementation Process
- Schein (1999), Process Consultation Revisited: Building the Helping Relationship, Involving the client system in diagnosis
- French and Bell, Organization Development: Behavioral Science Interventions for Organization Improvement, Systems view of organizations; survey feedback and participation in change
- Coch and French (1948), Overcoming resistance to change, Human Relations, 1(4), 512-532, Workers who took part in planning a change accepted it more readily than those who did not