title: Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches.
abstract: BACKGROUND
  The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change.
  
  
  METHODS
  We conducted a theory-driven evaluation of the organizational impact of healthcare leaders' participation in two training programs using a logic model based on Nonaka's theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed.
  
  
  RESULTS
  We found that the impact of training could primarily be felt in trainees' immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members.
  
  
  CONCLUSIONS
  Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence--both positive and negative--of specific organizational factors on extending the impact of training programs.
authors.forename: François
authors.initials: F
authors.lastname: Champagne
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St,, 4th floor, Toronto, ON M5T 3 M6, Canada. l.lemieux.charles@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Lemieux-Charles
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Duranceau
authors.forename: Gail
authors.initials: G
authors.lastname: MacKean
authors.forename: Trish
authors.initials: T
authors.lastname: Reay
mesh_terms: D001290:Attitude; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D004777:Environment; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006270:Health Facility Administrators; D006801:Humans; D007398:Interpersonal Relations; D007857:Leadership; D019982:Organizational Case Studies; D009936:Organizational Innovation; D013192:Staff Development / Q000458:organization & administration*