Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization.

INTRODUCTION: Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure. OBJECTIVES: The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness. METHODS: A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics. RESULTS: Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for. CONCLUSION: Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.

Maternal and child health in Albania.

Women in Albania today live in a world very different from that of their parents and grandparents. In an increasingly "westernized" nation, women initially appear to have more autonomy within their families and greater power within society than their traditional ancestors had. From the reports of aid agencies and the former government, it appears that Albanian women's health has also greatly improved in the last half century. However, these reports are based largely on questionable statistics. At the same time, initial impressions based on women's public images can be deceptive. According to Albanian physicians, most of the data produced during the socialist era was falsified to improve the government's image. Furthermore, no comprehensive research projects have examined the multi-faceted nature of pregnancy including both social and physical factors. Albanian clinicians and international aid organizations need accurate indicators of maternal and child health to either corroborate or disprove the reports under discrepancy. The study reported here documents current health conditions for pregnant women and their offspring in Albania. Data for the study were collected in 1993 and 1994 from field sites throughout Albania. A total of 3250 medical charts from 1993 were abstracted from five maternity houses. Interviews were conducted during 1993-1994 with 1199 pregnant women who were followed through their pregnancies. Of these women, 938 were located at delivery. Their infants were weighed and assessed. The data show that infant birth weights, gestational ages and mortality rates are now comparable to the rest of Europe. Maternal disease rates and spontaneous and therapeutic abortion rates are also surprisingly low considering the previous reports. However, fertility rates remain relatively high compared to Western Europe. The results show that despite the degeneration of health services, maternal and child health in Albania is much better than expected and vastly improved over the pre-communist era.

Improving collaboration between researchers and communities.

Active collaboration between communities and researchers is critical to developing appropriate public health research strategies that address community concerns. To capture the perspectives of inner-city Seattle communities about issues in community-researcher partnerships, Seattle Partners for Healthy Communities conducted interviews with community members from the ethnically diverse neighborhoods of Central and Southeast Seattle. The results suggest that effective community-researcher collaborations require a paradigm shift from traditional practices to an approach that involves: acknowledging community contributions, recruiting and training minority people to participate in research teams, improving communication, sharing power, and valuing respect and diversity.

Researcher and researched--community perspectives: toward bridging the gap.

In the process of initiating a new community-based research project, the authors wanted to understand the experiences of community members and researchers in community-based research projects and to develop guidelines to improve future projects. They conducted qualitative, key informant interviews with 41 people involved at all levels of community-based research projects in Seattle. Respondents were identified using a snowball sampling technique. More problems than successes were discussed by informants, including dissatisfaction with the focus of research, which some said is marked by a lack of cultural appropriateness and relevance. Power imbalances, lack of trust, and communication difficulties impeded collaboration. According to respondents, many problems could be avoided if the community were involved from the beginning in setting research priorities and developing and implementing interventions. Meaningful collaboration between communities and researchers is characterized by early involvement of communities, power sharing, mutual respect, community benefit, and cultural sensitivity.

A woman's work is never done: women's work and pregnancy outcome in Albania.

Albania has undergone extreme social and political changes during the past five years. Conditions regarding women's work and its effect on reproductive health have been unknown. During the 1993 and 1994, a cohort of 1199 pregnant women were followed to identify how work factors related to spontaneous abortion, infant low birth weight, gestation length, and perinatal mortality. A small subgroup was interviewed to examine qualitative issues including motivation, attitudes, and personal experiences regarding working and raising a family. Results reveal that certain work factors directly correlated with low birth weight, miscarriage, and/or perinatal death. The significant factors included: fewer household helpers, standing, working in hot environment, commuting, walking and carrying, and lifting heavy weights on the job. Most women were unemployed, and virtually all were deeply concerned about employment and poverty. Their challenge is to maintain an equilibrium between satisfaction of economic needs and physical needs during pregnancy. International aid programs in Albanian maternal and child health must consider the physical repercussions from increased work on the job and little or no decrease in work at home.

Doing community-driven research: a description of Seattle Partners for Healthy Communities.

Seattle Partners, an Urban Research Center (URC) funded by the Centers for Disease Control and Prevention (CDC), is a partnership of community agency representatives, community activists, public health professionals, academics, and health care providers whose mission is to improve the health of urban Seattle, Washington, communities by conducting community-based participatory research. This article describes the development and characteristics of Seattle Partners. Using primarily qualitative methods, including periodic in-depth interviews, evaluators identified the components necessary for Seattle Partners to maintain a collaborative and establish a research center driven by community interests. Seattle Partners is run by an unrestricted and inclusive board that has spent 5 years developing both an operating structure and various research interventions. Operating under Community Collaboration Principles, the board identified social determinants of health as the priority area in which to work. Collaboration, "small and concrete" accomplishments, skilled individuals, and funder support directly influence the success of the center. Decision making, project selection, and board composition have all been challenges to work through. Learning how to do and sustain the work are lessons being learned as Seattle Partners matures.