728 - Delivery Room Organizational Culture and Impact on Provider Perceptions of Practice Implementation

Poster Number: 728
Publication Number: 728.244

Sara C. Handley, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, United States; Ingrid Nembhard, University of Pensylvania, Philadelphia, PA, United States; Molly Passarella, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Charlotte Cecarelli, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Christopher P. Bonafide, Children's Hospital of Philadelphia, Penn Valley, PA, United States; Henry Lee, University of California, San Diego School of Medicine, San Diego, CA, United States; Jennifer Cohen, Children's Hospital of Philadelphia, West Chester, PA, United States; Jennifer A. Tioseco, CHOP Newborn Care, Pomona, NJ, United States; John Chuo, Children's Hospital of Philadelphia, SPROUT, University of Pennsylvania, Asian/Pacific American, PA, United States; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States

Background: The Neonatal Resuscitation Program (NRP) disseminates evidence-based guidelines for neonatal resuscitation. Implementation of these guidelines is variable. In other settings, implementation depends on context, a core component of which is organizational culture (the beliefs, perceptions, and values in an organization). Identifying components of delivery room organizational culture that enable successful guideline implementation is critical to optimize resuscitation and outcomes.

Objective: To develop and validate a Resuscitation-specific Organizational Culture Instrument (ROCI) and test its association with provider-reported implementation outcomes.

Design/Methods: Informed by NRP key behavioral skills, published organizational culture scales measuring role clarity, shared-mental models, closed-loop communication, team adaptability, and psychological safety were adapted to create the ROCI (Table 1). The ROCI was administered as a cross-sectional survey to neonatal resuscitation team members (APPs, RNs, MD/DOs, and RTs) across the Children’s Hospital of Philadelphia Newborn Care Network. Survey psychometric properties were assessed using reliability (Cronbach’s a) and validity (confirmatory factor analysis [CFA]) statistics. ROCI scores, both overall and by subscale, were calculated (by averaging Likert scale responses) and associations with provider-reported outcomes (measures of implementation climate and provider-perceived implementation success) examined using regression models and predictive margins.

Results: There were 318 complete responses across 11 sites (median 33 responses/site, IQR 18-36); the majority of respondents identified as female (n=266) and were nurses (n=175). Of the original 22 items, 18 were retained and had excellent scale reliability (a=0.94) and very good subscale reliability (a=0.79-0.87). The CFA goodness-of-fit statistics showed validity of a 5-factor solution (SRMR=0.048, RMSEA=0.034, CFI=0.95, TLI=0.94). Regression analyses at the individual-level found that higher ROCI scores, overall and for all subscales, were predictive of higher implementation climate and provider-reported implementation success (Table 2). In hospital-level, adjusted analysis, ROCI scores overall and for role clarity, shared-mental models, and closed-loop communication subscales were associated with higher provider-reported implementation success (Table 3).

Conclusion(s):

The ROCI is a reliable and valid measure of delivery room resuscitation organizational culture, predicts scores for provider-reported implementation outcomes, and may inform interventions to improve guideline implementation outcomes.