Organizational Change to Transfer Knowledge and Improve Quality and Outcomes of Care for Patients with Severe Mental Illness: A Systematic Overview of Reviews

By Franx, Gerdien; Kroon, Hans et al. | Canadian Journal of Psychiatry, May 2008 | Go to article overview

Organizational Change to Transfer Knowledge and Improve Quality and Outcomes of Care for Patients with Severe Mental Illness: A Systematic Overview of Reviews


Franx, Gerdien, Kroon, Hans, Grimshaw, Jeremy, Drake, Robert, Grol, Richard, Wensing, Michel, Canadian Journal of Psychiatry


Objective: To provide a comprehensive overview of the research on organizational changes aimed at improving health care for patients with severe mental illness and to learn lessons for mental health practice from the results.

Method: We searched for systematic literature reviews published in English during 2000 to 2007 in PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Central Register of Systematic Reviews. Three reviewers independently selected and assessed the studies' quality. Studies involving changes of who delivers health care, how care is organized, or where care is delivered were included. We categorized the studies using an existing taxonomy of 6 broad categories of strategies for organizational change.

Results: A total of 21 reviews were included. Among these, 17 had reasonably good methodological quality. Almost all reviews included or intended to include randomized controlled trials (RCTs), 6 reviews did not identify studies that met eligibility criteria. Multidisciplinary teams and integrated care models had been reviewed most frequently (a total of 15 reviews). In most studies, these types of changes showed better outcomes in terms of symptom severity, functioning, employment, and housing, compared with conventional services. Different results were found on cost savings. Other types of organizational changes, such as changing professional roles or introducing quality management or knowledge management, were much less frequently reviewed. Very few reviews looked at effects of organizational changes on professional performance.

Conclusions: There is a fairly large body of evidence of the positive impact of multidisciplinary teams and integrated care changes on symptom severity, functioning, employment, and housing of people with severe mental illness, compared with conventional services. Other strategies, such as changes in professional roles, quality or knowledge management, have either not been the subject of systematic reviews or have not been evaluated in RCTs. There is still a lack of insight in the so-called black box of change processes and the impact of change on professional performance.

Can J Psychiatry 2008;53(5):294-305

Clinical Implications

* Multidisciplinary teams and integrated care services can improve the quality of care and should be promoted in the severe mental health care setting.

* The lack of insight into processes of change and effects of implementation projects on professional and organizational performance can hinder practitioners and managers who want to improve care for people with chronic mental illness.

* Popular and costly organizational changes used in daily practice, such as quality management or routine outcome measurement and the introduction of computer systems, have not been studied by systematic reviews.

Limitations

* Our review assessed only recent systematic reviews.

* Single studies were excluded, although many exist.

* Reviews mainly focused on RCTs, although implementation studies of less rigorous quality exist.

Key Words: organizational change, implementation, severe mental illness

Abbreviations used in this article

ACT Assertive Community Treatment

CI confidence interval

CMHT community mental health team

FEP first episode psychosis

NNT number needed to treat

OR odds ratio

PSI percentage of studies with improvements

RCT randomized contolled trial

RR relative risk

WMD weighted mean difference

The challenges posed by chronic illnesses are especially pertinent to mental health care, as the prevalence and costs of chronic mental illness are growing and a clear perspective on their management is lacking.1 Chronic mental illness includes schizophrenia and related disorders, bipolar disorder, and depression with psychotic features. Schizophrenia is the most frequently diagnosed disorder among patients with severe mental illness, affecting 1% of the Canadian population.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Organizational Change to Transfer Knowledge and Improve Quality and Outcomes of Care for Patients with Severe Mental Illness: A Systematic Overview of Reviews
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.