title: Impact of Organizational Stability on Adoption of Quality-Improvement Interventions for Diabetes in Primary Care Settings.
abstract: OBJECTIVE
  Although there have been tremendous advances in diabetes care, including the development of efficacious interventions, there remain considerable challenges in translating these advances into practice. Four primary care networks (PCNs) in Alberta implemented 2 quality-improvement interventions focused on lifestyle and depression as part of the Alberta's Caring for Diabetes (ABCD) project.
  
  
  METHODS
  We used the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework to evaluate adoption of the quality-improvement interventions in the PCN setting. We undertook semistructured interviews with PCN staff (n=24); systematic documentation (e.g. field notes) and formal reflections by the research team (n=4). Content analysis was used to interrogate the data.
  
  
  RESULTS
  The Ready? Set? Go! construct summarizes our findings well. We observed that the participating PCNs were in a favourable position to adopt the 2 interventions successfully. We implemented strategies to promote adoption (Ready), and respondents reported prioritization and willingness to initiate the interventions based on positive indicators (Set). Regardless, the interplay of organizational stability, leadership support, existing physician culture and organizational context influenced the overall degree of adoption of the interventions across the PCNs (Go).
  
  
  CONCLUSIONS
  Our findings suggest that implementation of quality-improvement interventions into settings similar to the PCNs we studied will have the greatest likelihood of success when there is priority alignment, genuine and sustained leadership support and an innovative organizational culture. However, the stability of organizations may affect the degree to which staff can adopt quality-improvement interventions successfully, so organizational stability should be assessed on an ongoing basis.
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wozniak
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Soprovich
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rees
authors.affiliation: Leduc Beaumont Devon Primary Care Network, Leduc, Alberta, Canada.
authors.forename: Len
authors.initials: L
authors.lastname: Frank
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada; Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Johnson
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Canada. Electronic address: jeff.johnson@ualberta.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*
keywords: RE-AIM; adoption; interventions visant l'amélioration de la qualité; primary care; quality-improvement interventions; soins primaires