Organizational process: a missing link between research and practice

Organizational process is an underexamined barrier and a potential bridge for the introduction of innovative treatment models into mental health practice. The author describes key operational characteristics of large, complex organizations and strategies that have been used to facilitate implementation of innovative programs in the Department of Veterans Affairs health care system. He argues that complex organizations of the type in which mental health care is increasingly delivered are characterized by multiple competing goals, uncertain technologies, and fluid involvement of key participants. Interventions shown to be effective in controlled studies are often not easily introduced into such organizations, because research is typically conducted in a buffered organizational niche that is shielded from the complex open systems around it. Key strategies for moving research into practice include constructing decision-making coalitions, linking new initiatives to legitimated goals and values, quantitatively monitoring implementation and ongoing performance, and developing self-sustaining communities of practice as well as learning organizations. The author shows how effective dissemination of new treatment methods requires attention to and effective engagement with organizational processes.