Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: A systematic overview of reviews. Franx, G., Kroon, H., Grimshaw, J., Drake, R., Grol, R., & Wensing, M. Canadian Journal of Psychiatry, 53(5):294-305, 2008.
Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: A systematic overview of reviews [link]Website  abstract   bibtex   
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.
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 title = {Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: A systematic overview of reviews},
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 year = {2008},
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 keywords = {CINAHL,Cochrane Library,EMBASE,Health Knowledge, Attitudes, Practice,Humans,Implementation,MEDLINE,Mental Disorders,Mental Health Services,Organizational Innovation,Organizational change,PsycINFO,Severe mental illness,Transfer (Psychology),clinical practice,cost control,disease severity,employment,general hospital,health care delivery,health care organization,health care quality,housing,human,information retrieval,job performance,knowledge management,medical service,mental disease,mental health care,mental health care personnel,mental health service,methodology,outcome assessment,review,symptomatology,systematic review,taxonomy,team building,vocational rehabilitation},
 pages = {294-305},
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 city = {Affiliation: Department Innovation of Mental Health Care, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Affiliation: Department Reintegration and Community Care, Trimbos-instituut, Netherlands Institute of },
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 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.},
 bibtype = {article},
 author = {Franx, G and Kroon, H and Grimshaw, J and Drake, R and Grol, R and Wensing, M},
 journal = {Canadian Journal of Psychiatry},
 number = {5}
}
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