Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: a systematic overview of reviews.

Full Abstract

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.

Learn Faster Today Improve your study skills

Author information

Author/s: Franx, Gerdien (G); Kroon, Hans (H); Grimshaw, Jeremy (J); Drake, Robert (R); Grol, Richard (R); Wensing, Michel (M);

Affiliation: Department of Innovation of Mental Health Care, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands] gfranx(-atsign-)trimbos.nl

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: Canadian journal of psychiatry. Revue canadienne de psychiatrie (Can J Psychiatry), published in Canada. (Language: eng)

Reference: 2008-May; vol 53 (issue 5) : pp 294-305

Dates: Created 2008/06/16; Completed 2008/08/12;

PMID: 18551850, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Can J Psychiatry. 2008 May;53(5):275-6. (PMID: 18551848)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Health Knowledge, Attitudes, Practice
Humans
Mental Disorders - drug therapy; psychology; therapy

Mental Health Services - organization & administration; standards
Organizational Innovation
Transfer (Psychology)

These are the highest related articles currently in the database:

See 100+ related articles.