Predicting implementation from organizational readiness for change: a study protocol

<p>Abstract</p> <p>Background</p> <p>There is widespread interest in measuring organizational readiness to implement evidence-based practices in clinical care. However, there are a number of challenges to validating organizational measures, including inferential bias arising from the halo effect and method bias - two threats to validity that, while well-documented by organizational scholars, are often ignored in health services research. We describe a protocol to comprehensively assess the psychometric properties of a previously developed survey, the Organizational Readiness to Change Assessment.</p> <p>Objectives</p> <p>Our objective is to conduct a comprehensive assessment of the psychometric properties of the Organizational Readiness to Change Assessment incorporating methods specifically to address threats from halo effect and method bias.</p> <p>Methods and Design</p> <p>We will conduct three sets of analyses using longitudinal, secondary data from four partner projects, each testing interventions to improve the implementation of an evidence-based clinical practice. Partner projects field the Organizational Readiness to Change Assessment at baseline (n = 208 respondents; 53 facilities), and prospectively assesses the degree to which the evidence-based practice is implemented. We will conduct predictive and concurrent validities using hierarchical linear modeling and multivariate regression, respectively. For predictive validity, the outcome is the change from baseline to follow-up in the use of the evidence-based practice. We will use intra-class correlations derived from hierarchical linear models to assess inter-rater reliability. Two partner projects will also field measures of job satisfaction for convergent and discriminant validity analyses, and will field Organizational Readiness to Change Assessment measures at follow-up for concurrent validity (n = 158 respondents; 33 facilities). Convergent and discriminant validities will test associations between organizational readiness and different aspects of job satisfaction: satisfaction with leadership, which should be highly correlated with readiness, versus satisfaction with salary, which should be less correlated with readiness. Content validity will be assessed using an expert panel and modified Delphi technique.</p> <p>Discussion</p> <p>We propose a comprehensive protocol for validating a survey instrument for assessing organizational readiness to change that specifically addresses key threats of bias related to halo effect, method bias and questions of construct validity that often go unexplored in research using measures of organizational constructs.</p

The Role of Fatigue in the Aging Swallow: A Review

Fatigue is a term commonly used to describe patient performance and/or subjective experience in the evaluation and management of swallowing disorders (known as dysphagia). There is an association between fatigue and aging, as well as fatigue and many dysphagia-causing diseases/disorders. Therefore, speech-language pathologists (SLPs) are justifiably aware of and concerned about the potential impact of fatigue on swallowing performance and mealtime behavior. However, there is minimal agreement on and understanding of what constitutes swallowing-related fatigue, how it is identified and measured, who is at risk, and its impact on swallowing function, overall health, and quality of life. The purpose of this review is to discuss the role of fatigue in swallowing and eating behavior in the context of aging, and how fatigue may be measured and managed clinically. We review the concept of fatigue and its clinical implications for swallowing function and mealtime behavior through the dichotomous framework of self-perceived fatigue versus measurable fatigability. Quantitative fatigability and patient-reported fatigue are discussed. We conclude with implications for future research.</jats:p