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Navigating the storm: How proficient organizational culture promotes clinician retention in the shift to evidence-based practice

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  • Nathaniel J Williams
  • Rinad S Beidas

Abstract

Objective: Clinician turnover is a major concern as mental health systems and organizations invest substantial resources in the implementation of evidence-based practice (EBP). In this study, we identify malleable factors associated with reduced clinician turnover during a system-wide EBP implementation initiative. Specifically, we examine how proficient organizational culture (i.e., norms and behavioral expectations that clinicians prioritize improvement in client well-being and exhibit competence in up-to-date treatment practices), EBP implementation climate (i.e., perceptions that the organization’s policies, procedures, and practices support EBP use), and change in these organizational characteristics relate to clinician turnover during a system-wide EBP transformation. Method: Data were collected from 236 clinicians in 19 mental health clinics across 3 years of a system-wide EBP implementation initiative in the City of Philadelphia. Clinicians reported on proficient organizational culture and EBP implementation climate at baseline (T1) and two-year follow-up (T2). Administrators reported on clinician turnover at three-year follow-up (T3). Hypotheses were tested via multilevel mediation analyses incorporating mixed effects logistic regression models. Results: Controlling for organization size, clinician job satisfaction, attitudes towards EBP, job tenure, and age, higher levels of proficient organizational culture and improvement in proficient culture from baseline to two-year follow-up predicted reduced clinician turnover in the year following; these effects were mediated by EBP implementation climate and by improvement in EBP implementation climate, respectively. Conclusions: Organizations with more proficient cultures have more supportive EBP implementation climates that predict reduced clinician turnover during system-wide EBP implementation initiatives. Strategies that target these antecedents in mental health service organizations may contribute to reduced clinician turnover.

Suggested Citation

  • Nathaniel J Williams & Rinad S Beidas, 2018. "Navigating the storm: How proficient organizational culture promotes clinician retention in the shift to evidence-based practice," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-20, December.
    • Handle: RePEc:plo:pone00:0209745
    DOI: 10.1371/journal.pone.0209745
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    1. Babbar, Shaili & Adams, Danielle R. & Becker-Haimes, Emily M. & Skriner, Laura C. & Kratz, Hilary E. & Cliggitt, Lauren & Inacker, Patty & Beidas, Rinad S., 2018. "Therapist turnover and client non-attendance," Children and Youth Services Review, Elsevier, vol. 93(C), pages 12-16.
    2. Aarons, G.A. & Wells, R.S. & Zagursky, K. & Fettes, D.L. & Palinkas, L.A., 2009. "Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis," American Journal of Public Health, American Public Health Association, vol. 99(11), pages 2087-2095.
    3. Williams, Nathaniel J. & Glisson, Charles, 2013. "Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare," Children and Youth Services Review, Elsevier, vol. 35(11), pages 1871-1877.
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