title: Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.
abstract: BACKGROUND
  Substance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation.
  
  
  METHODS
  Direct service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire "fit continuum".
  
  
  RESULTS
  Discrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use.
  
  
  CONCLUSIONS
  The current research benefits from a strong theoretical framework, consistent findings, and significant practical implications for substance abuse treatment agencies. Comprehensive attempts to strengthen outcomes related to EBP implementation must consider both provider- and agency-level characteristics regarding EBP use. Organizational efforts to more closely align provider attitudes and agency priorities will likely constitute a key strategy in fostering the implementation of EBPs in substance abuse treatment organizations.
authors.affiliation: Washington University Brown School of Social Work, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA. aramsey@wustl.edu.
authors.forename: Alex T
authors.initials: AT
authors.lastname: Ramsey
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, Missouri, 63110, USA. vandenbc@psychiatry.wustl.edu.|Veterans Health Administration Research and Development, 501 N. Grand Blvd., St. Louis Healthcare System, St. Louis, Missouri, 63103, USA. vandenbc@psychiatry.wustl.edu.|Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA. vandenbc@psychiatry.wustl.edu.
authors.forename: Carissa
authors.initials: C
authors.lastname: van den Berk-Clark
mesh_terms: D003710:Demography; D055317:Evidence-Based Practice; D005260:Female; D006282:Health Personnel; D006801:Humans; D007858:Learning; D008297:Male; D009013:Morale; D019966:Substance-Related Disorders / Q000628:therapy*