Abstract：
Objectives: Healthcare organization leaders\' support is critical for successful implementation of new practices, including complementary and integrative health (CIH) therapies. Yet little is known about how to garner this support and what motivates leaders to support these therapies. We examined reasons leaders provided or withheld support for CIH therapy implementation, using a multilevel lens to understand motivations influenced by individual, interpersonal, organizational, and system determinants. Design and setting: We conducted qualitative interviews with leaders in seven Veterans Health Administration medical centers that offered at least three CIH therapies to Veterans and were identified as early adopters of CIH therapies. Subjects: Participants included 12 executive leaders and 34 leaders of key clinical services, including primary care, mental health, physical medicine and rehabilitation, and pain. Measures: We used a thematic analysis to examine leaders\' narratives of barriers and facilitators to implementation including their attitudes toward CIH therapies, perceptions of evidence, engagement in implementation, and decisions to provide concrete support for CIH therapies. Drawing from Greenhalgh\'s Diffusion of Innovation framework, we organized themes according to the influence of individual determinants, two levels of inner setting, and outer system context on CIH implementation. Results: Leaders\' decisions to provide or withhold support were driven by considerations across multiple levels including (1) individual attitudes/knowledge, perceptions of evidence, and personal experiences; (2) interpersonal interactions with trusted brokers, patients, and loved ones/colleagues/staff; (3) organizational concerns surrounding relative priorities, local resources, and metrics/quality/safety; and (4) system-level policy, bureaucracy, and interorganizational networks. These considerations interacted across levels, with components at organizational and system levels sometimes prevailing over individual perceptions and experiences. Conclusions: Garnering leaders\' support for CIH therapy implementation should address their considerations at multiple levels. Implementation strategies designed to shift individual attitudes alone may be insufficient for securing leaders\' support without attention to broader organizational and system-level contextual issues.
摘要：
目标：医疗机构领导者的支持对于新实践的成功实施至关重要，包括补充和综合健康（CIH）疗法。然而，人们对如何获得这种支持以及是什么促使领导者支持这些疗法知之甚少。我们检查了领导人为CIH治疗实施提供或拒绝支持的原因，使用多层次的镜头来理解受个人影响的动机，人际关系,组织，和系统决定因素。设计和设置：我们对七个退伍军人健康管理局医疗中心的领导者进行了定性访谈，这些医疗中心为退伍军人提供了至少三种CIH疗法，并被确定为CIH疗法的早期采用者。受试者：参与者包括12位执行领导人和34位主要临床服务领导人，包括初级保健，心理健康,物理医学和康复，和痛苦。措施：我们使用主题分析来检查领导者对实施障碍和促进者的叙述，包括他们对CIH疗法的态度，对证据的看法，参与执行，以及为CIH疗法提供具体支持的决定。借鉴格林哈尔的创新扩散框架，我们根据个体决定因素的影响来组织主题，内部设置的两个级别，和外部系统上下文onCIH实现。结果：领导者提供或拒绝支持的决定是由多个层面的考虑驱动的，包括（1）个人态度/知识，对证据的看法，和个人经历；(2)与可信经纪人的人际交往，病人,和亲人/同事/员工；(3)围绕相对优先事项的组织关注，当地资源,和指标/质量/安全；和(4)系统级政策，官僚主义,和组织间网络。这些考虑因素在各个级别之间相互作用，组织和系统层面的组件有时会超过个人的看法和经验。结论：获得领导者对CIH治疗实施的支持应在多个层面解决他们的考虑。仅旨在改变个人态度的实施策略可能不足以确保领导者的支持，而不关注更广泛的组织和系统级别的上下文问题。
