Hospital-based health technology assessment in France: How can we do more and better?

Background: Long-term use of innovations is more likely where favourable contextual conditions are in place, yet relatively little empirical research has taken up the question of how evidence-based practices are sustained and become established in day-to-day practice. Objective: The purpose of this study was to examine the relationship between the learning climate, change readiness climate and perceived permanence of a decision-aid for lupus patients in 15 geographically diverse rheumatology clinics in the United States. Methods: A concurrent mixed methods approach was used. Results: Quantitative data from three rounds of surveys among clinic personnel revealed that clinics with a more positive change efficacy climate were more likely to have respondents who reported positive perceptions of decision aid permanence. Conversely, the internal and external learning climates were found to act as barriers to sustaining the decision aid. Qualitative findings revealed that the negative relationships observed between the learning environment and perceived permanence of the decision aid may arise from various factors, such as practice pattern differences, differential utility of the decision aid, buy-in from physicians, and other. Conclusions: The findings reinforce the importance of organizational climate, not just for the initial implementation stage, but also for sustainment of change. Early consideration of organizational climate measures is crucial during the planning phase of organizational change projects. Additionally, ongoing evaluation and feedback mechanisms are necessary to address issues and maintain engagement, ultimately supporting the sustained use of the innovation. Clinical Trial: N/A

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