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Cultural change is a marathon, not a sprint, according to a recent paper in the Archives of Physical Medicine & Rehabilitation. The research examined clinicians’ beliefs about organizational change and evidence-based practice as a leading rehabilitation hospital moved into a new building designed to accelerate translational research.
The study surveyed clinicians before and after the Rehabilitation Institute of Chicago moved into a new state-of-the-art building to become Shirley Ryan AbilityLab in 2017. Organizational changes, new funding opportunities and other incentives designed to encourage collaboration between clinicians and scientists accompanied the move.
In the new building, clinicians would be co-located with researchers to help speed the translation of scientific discoveries into cutting-edge patient care, making it the first translational rehabilitation research hospital in the United States. In the original building, patient care and research were conducted in different locations.
“Bringing together researchers and clinicians was going to be a huge change, but the physical changes were just part of our overall organizational transformation,” said Miriam Rafferty, PT, DPT, PhD, Director of Implementation Science at Shirley Ryan AbilityLab and lead author of the paper. “There were also accompanying cultural and team-based strategies to support translational research,” explained Rafferty, who is also Assistant Professor at Northwestern University’s Feinberg School of Medicine in the Departments of Physical Medicine & Rehabilitation and Psychiatry & Behavioral Science.
“We were excited about the move, but we also knew there would be a transition period and potential unforeseen outcomes so we decided to evaluate ourselves just before, just after and then years later, once we had a chance to settle in,” said Melissa Briody, Research Program Manager at Shirley Ryan AbilityLab and a co-author on the paper.
Clinicians completed several surveys 1-2 months before the move (n=410), 7-9 months after the move (n= 442) and 2.5 years (n=448) after the move to measure beliefs about the organizational change and how it affected their openness to evidence-based practice.
Evidence-based practice is a term used to describe the translation of scientific evidence into real-world clinical settings. Key principles of evidence-based practice include asking questions and seeking out information, evaluating new findings, measuring results and integrating evidence with clinical expertise in delivering patient care. “We thought that, with the move to this new building and model of care, people would be even more open to the idea of translational medicine, so we wanted to measure openness to evidence-based practice,” said Briody.
The surveys also measured acceptance of organizational changes, participation in new initiatives, rates of cross-discipline communication and participation in research activities.
Acceptance of the new model of care decreased between the first and second surveys, but rebounded by the time the third survey was administered 2.5 years after the move.
Clinicians surveyed before the move were neutral or positive about the transition and evidence-based practices. Six months after the move, their attitudes toward the change and evidence-based practices decreased slightly. Responses from open-ended survey questions indicated that there were difficulties related to communication and collaboration with researchers, lack of time to engage in research and limited bandwidth.
“At six months, we saw that people were still getting used to the new structure and their attitudes toward the organizational change were more neutral compared with before the move when survey respondents felt either neutral or positive about the change,” explained Rafferty.
However, attitudes toward the organizational change and openness to evidence-based practice rose back to neutral or positive in the third survey, indicating optimism for the new translational model of care.
The researchers believe that staff optimism may have been supported by new incentives and employee engagement initiatives rolled out between the second and third surveys, including the development of team-focused strategies, educational and “lunch and learn” opportunities and the expansion of internal funding sources to help clinicians develop research ideas.
“While clinicians perceived the move to a new, state-of-the-art facility as exciting, the accompanying culture changes related to communication and collaboration took two years to take shape fully,” notes Rafferty. “Major changes like the one we underwent to become Shirley Ryan AbilityLab often involve a period of disruption and adjustment, which is exactly what we saw in our study. New internal, team-based and leadership initiatives to support changes catalyzed by our new physical environment were key to improving attitudes toward the transformation.”
For the full paper, see https://doi.org/10.1016/j.apmr.2023.02.014
