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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TL;DR: It was found that alliance was related to both drug and alcohol use during the past week at the patient and program levels of analysis, but not the counselor level, and several program characteristics were related to average drug andalcohol use.
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Cites background or result from "The staff workplace and the quality..."
...Such program factors have been found to be associated with patient substance use outcomes (Moos & Moos, 1998), as well as measures of treatment participation, treatment retention, and treatment satisfaction (Greener, Joe, Simpson, Rowan-Szal, & Lehman, 2007; Lehman, Greener, & Simpson, 2002)....
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...The findings in this study, namely, that certain aspects of organizational functioning of programs are associated with ongoing patient-reported drug/alcohol use, replicate previous research in substance abuse treatment programs (Moos & Moos, 1998; Lehman et al., 2002; Greener et al., 2007)....
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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.
1,392Â 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.
1,141Â 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.
766Â 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.
703Â 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.
462Â citations