The staff workplace and the quality and outcome of substance abuse treatment.
01 Jan 1998-Journal of Studies on Alcohol and Drugs (Rutgers University Piscataway, NJ)-Vol. 59, Iss: 1, pp 43-51
TL;DR: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment.
Abstract: Objective: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment. Method: Patient care staff (N = 329) in 15 substance abuse treatment programs reported on the characteristics of their work environment and on their beliefs and treatment orientations about substance abuse. Patients in these programs (N = 3,228) reported on the treatment environment, their participation in treatment and self-help activities, and their treatment goals, confidence in achieving these goals, and coping skills at intake to and discharge from treatment. Results: Staff in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment. These work environments were associated with more supportive and goal-directed treatment environments. Pa...
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01 Jan 2012
TL;DR: The findings from this study support the use of detox-to-treatment transfer rates as a performance measure for treatment systems with greater efficiency.
Abstract: The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance abuse treatment systems. One major service gap in the continuum of care for substance use disorders associated with readmissions is not transitioning patients to rehabilitation after a detox service. This study examined the problem of detox readmissions from an interorganizational network perspective. There were four aims: 1) determine the extent to which detox patients transfer to rehabilitation within 14 days of discharge from a detox service, 2) map the linkages between treatment programs, 3) test the impact of detox programs' network ties on their patients' odds of readmission to a detox service within one year, and 4) evaluate the utility of patient transfer rates as a county-level performance measure for detox. Data are from the California Outcomes Measurement System. I used admission and discharge data for all patients treated in 2008-2009 in 32 counties to map linkages between treatment programs and measure structural features of detox programs' local networks using social network analysis. I used multi-level analysis to predict the odds of patient readmissions to detox. Contextual predictors included out-degree (number of out-going ties to other programs) and efficiency (proportion of direct ties within a network that are non-redundant ). The total number of patients in the dataset was 150,955, including 25,423 detox patients. Approximately 28% of detox patients transferred to some form of rehabilitation care after detox. Transitioning from detox to rehabilitation within 14 days of discharge was associated with lower odds of readmissions (for residential detox: OR .48, 95% CI .40, .57; for narcotic treatment detox: OR .25, 95% CI .19, .32). Network efficiency was associated with lower odds of readmission (for residential detox: OR .25, 95% CI .08, .83; for narcotic treatment detox: OR .34, 95% CI .14, .82). Detox programs with greater efficiency are able to access diverse referral resources. The findings from this study support the use of detox-to-treatment transfer rates as a performance measure for treatment systems.
2 citations
Cites background from "The staff workplace and the quality..."
...Organizational environments impact the behavior of staff and the treatment of patients (Moos & Moos, 1998)....
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TL;DR: In this paper, a grounded theory project designed to explore client satisfaction within a community-based counseling centre was presented, with twenty-two client participants and seven worker participants participating in the project.
Abstract: This article discusses a grounded theory project designed to explore client satisfaction within a community-based counselling centre. Twenty-two client participants and seven worker participants sh...
2 citations
01 Jan 2002
TL;DR: In this paper, the authors examine elements within the organizational and team context that can maximize or inhibit team performance and find that when the context is perceived positively, employees and teams are more likely to thrive and be productive, when it is perceived negatively, frustration, dissatisfaction, and low productivity result.
Abstract: Context is the social-psychological atmosphere, environment, milieu, or climate of the organization and the team. Context is important because it directly influences the quality of processes and tasks carried out in the organization and the team. When the context is perceived positively, employees and teams are more likely to thrive and be productive. When it is perceived negatively, frustration, dissatisfaction, and low productivity result. This chapter examines elements within the organizational and team context that can maximize or inhibit team performance.
2 citations
01 Jan 2014
TL;DR: In this article, the authors examined the role of AoD training and professional support on psychologists' functioning as AoD counselors and found that professional support would make a unique contribution to the prediction model.
Abstract: Alcohol and other drug (AoD) problems occur at epidemic levels in society, yet many individuals do not receive adequate treatment. Research suggests that psychologists are disinterested in AoD counseling, and have AoD training, attitude, and skill deficits. The current study examined the role of AoD training and professional support on psychologists’ functioning as AoD counselors. The ultimate purpose of the study was to determine what interventions may be useful for improving psychologists’ ability to provide AoD counseling. One hundred and seventy eight members of four divisions of the American Psychological Association were surveyed using a measure developed by the author based on prior research. Regression analyses confirmed the hypothesis that AoD training would be predictive of psychologists’ functioning as AoD counselors; and that professional support would make a unique contribution to the prediction model.
2 citations
Cites background or result from "The staff workplace and the quality..."
...…Amodeo, 2001; Broadus et al., 2010; Cartwright, 1980; Cartwright & Gorman (1993); CSAT, 2006; Davis & Taylor-Vaisey, 1997; Hunot & Rosenbach, 1998; Lightfoot & Orford, 1986; Loughran et al., 2010; Lubin et al., 1986; Moos & Moos, 1998; Shaw et al., 1978; Skinner, Roche, Freeman, & Addy, 2005)....
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...…work outcomes (Addy et al., 2004; Albery, 2003; Amodeo, 2000; Broadus et al., 2010; Cartwright & Gorman, 1993; CSAT, 2006; Davis & Taylor-Vaisey, 1997; Hunot & Rosenbach, 1998; Knudsen, Johnson, & Roman, 2003; Lubin et al., 1986; Moos and Moos, 1998; Rhoades & Eisenberger, 2002; Skinner, 2005)....
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...…et al., 2002; Amodeo, 2000; Amodeo, 2001; Broadus et al., 2010; Cartwright, 1980; Cartwright & Gorman (1993); CSAT, 2006; Davis & Taylor-Vaisey, 1997; Lightfoot & Orford, 1986; Loughran et al., 2010; Lubin et al., 1986; Moos & Moos, 1998; Shaw et al., 1978; Skinner, Roche, Freeman, & Addy, 2005)....
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...Moos and Moos (1998) concluded that the findings suggest that organizational structure plays an important role in reducing role ambiguity and conflict among different professionals working together, developing trust and rapport with supervisors to manage 94 difficult client situations, and…...
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...Likewise, Murdock et al. (2005) found that, compared to non-certified clinicians, certified addiction professionals had higher self-efficacy to practice AoD counseling....
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References
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TL;DR: An 18-item version of the Client Satisfaction Questionnaire (CSQ-18) was included in an experimental study of the effects of pretherapy orientation on psychotherapy outcome and demonstrated that a subset of items from the scale performed as well as the CSQ-8 and often better.
1,392 citations
TL;DR: The analysis both confirmed the 10-process model and revealed two secondary factors, Experiential and Behavioral, which were composed of 5 processeseach and reflected hou.
Abstract: Subjects (A' = 970) representing five stages of smoking cessation (precontemplation, contemplation,action, maintenance, and relapse) were given a 65-item test measuring 10 basic processes of change.Subjects recorded the last time they quit smoking, their current use, the frequency of occurrence,and the degree of item helpfulness. A 40-item questionnaire provided highly reliable measures of 10processes of change, labeled (a)consciousness raising, (b) dramatic relief, (c) self-liberation, (d)socialliberation, (e) counterconditioning, (f) stimulus control, (g) self-reevaluation, (h) environmental re-evaluation, (i) reinforcement management, and (j) helping relationship. In a confirmatory analysis,770 subjects were assessed 6 months later. The analysis both confirmed the 10-process model andrevealed two secondary factors, Experiential and Behavioral, which were composed of 5 processeseach and reflected hou. individuals in particular stages use more lhan I process at a time. The trans-theoretical model of change and available external validity evidence are reviewed.
1,141 citations
TL;DR: In this paper, the authors examined the factors associated with risk-adjusted mortality, risk adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs.
Abstract: A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. Based on data collected from 17,440 patients across 42 ICUs, the present study examines the factors associated with risk-adjusted mortality, risk-adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs. Using the Apache III methodology for risk-adjustment, findings reveal that: 1) technological availability is significantly associated with lower risk-adjusted mortality (beta = -.42); 2) diagnostic diversity is significantly associated with greater risk-adjusted mortality (beta = .46); and 3) caregiver interaction comprising the culture, leadership, coordination, communication, and conflict management abilities of the unit is significantly associated with lower risk-adjusted length of stay (beta = .34), lower nurse turnover (beta = -.36), higher evaluated technical quality of care (beta = .81), and greater evaluated ability to meet family member needs (beta = .74). Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.
766 citations
Journal Article•
TL;DR: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation and was positively associated with greater perceived patient outcomes and human resource development.
Abstract: Objective This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Data sources and study setting Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. Study design The study involved cross-sectional examination of the named relationships. Data collection/extraction methods Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. Principal findings A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. Conclusions What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.
703 citations
Book•
21 Jun 1990TL;DR: Evaluating and improving alcoholism treatment programsObjectives, methods, and assessment of treatment implementation Short-term outcome and patient prognosis Gender and marital status in treatment and outcome.
Abstract: PART I. A SYSTEMS EVALUATION OF ALCOHOLISM TREATMENT: Evaluating and improving alcoholism treatment programs Objectives, methods, and assessment of treatment implementation Short-term outcome and patient prognosis The process and effects of treatment Gender and marital status in treatment and outcome PART II. EXTRATREATMENT FACTORS AND THE RECOVERY PROCESS: Life stressors, social resources, and coping responses Context, coping, and treatment outcome The process of recovery and relapse PART III. ALCOHOLISM AND THE FAMILY: Spouses of alcoholic partners Children of alcoholic parents PART IV. PRACTICAL APPLICATIONS: Improving treatment, work, and family settings Implications for treatment and program evaluation Index.
462 citations