Unlocking Successful Mobility Program Implementation: Insights from the STRIDE Program
Hospital-associated disability due to inactivity is a significant concern, linked to negative outcomes such as delirium, falls, increased lengths of stay, and functional decline. To combat these risks, health systems are increasingly exploring mobility interventions as part of Age-Friendly Health System transformations.
A recent study published in INQUIRY: The Journal of Health Care Organization, Provision, and Financing sheds light on the crucial organizational characteristics that predict the successful adoption of evidence-based programs (EBPs) like STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans). STRIDE is an evidence-based hospital walking program that promotes early and supervised ambulation for patients, typically those aged 60 or older who can safely ambulate. It has been rigorously tested and shown to be associated with lower rates of discharge to skilled nursing facilities. While STRIDE has seen remarkable success, transitioning EBPs from research to widespread practice is often challenging, with 30% to 90% of implementation efforts failing. Understanding the unique contextual features of clinical sites is therefore vital for successful dissemination.
This research, leveraging a mixed-method design across 35 Veterans Affairs (VA) hospitals implementing STRIDE, explored how organizational characteristics influence program adoption. The study defined adoption as completing supervised walks with at least five unique hospitalized Veterans during months five to six after launch with low-touch implementation support. Only 31% of the participating hospitals met this initial adoption benchmark.
The study identified several key organizational characteristics that significantly influenced adoption:
- Hospital Complexity: Hospitals with lower complexity scores demonstrated a substantially higher adoption rate (48%) compared to those with the highest complexity scores (7%). Higher complexity may be a proxy for increased competing priorities, which can limit a team’s capacity to introduce new programs.
- Material Support/Resources: Hospitals that received supplemental resources or staffing support for their STRIDE programs were significantly more likely to meet adoption benchmarks (43%) than those without such resources (29%). This highlights resource availability as a crucial driver for EBP adoption.
- Prior Implementation Experience: Experience mattered considerably, as 35% of hospitals with at least some experience implementing EBPs met the adoption benchmark, compared to 0% of those with very little to no experience. Qualitative findings further showed that hospitals with previous experience expressed a strong commitment to implementing new programs.
- Organizational Resilience: Adopting hospitals reported higher organizational resilience (mean = 23.5) than non-adopters (mean = 22.7). Organizational resilience reflects a site’s ability to adapt and change in response to new or unexpected challenges, such as implementing a new program.
- Organizational Readiness to Change: Hospitals that successfully adopted STRIDE reported greater organizational readiness to change (mean = 4.2) compared to those that did not (mean = 3.8). This commitment to and efficacy for change has previously been linked to successful implementation.
Interestingly, implementation climate was not consistently associated with successful adoption in this study. Qualitative data also revealed that while staff commitment to STRIDE was high across all sites, significant barriers to adoption included competing priorities and challenges with staffing, particularly hiring delays. Adopters often reported having adequate staff as a facilitator.
Implications for Practice and Future Initiatives: This research suggests that easily assessable contextual factors, such as resource availability and facility complexity, may have a more pronounced influence on program adoption with low-touch implementation support than more complex, validated measures like organizational readiness or climate. This insight can help health systems streamline their measurement efforts for future projects and prioritize sites with contexts most likely to support successful adoption, leading to more efficient use of implementation resources.
The study underscores the critical importance of understanding organizational context for scaling up effective interventions and ensuring patients receive known effective care. It calls for continued research into the causal pathways of modifiable organizational characteristics that drive implementation success.
APA Reference for the article:
Zullig, L. L., Drake, C., Webster, A., Tucker, M., Choate, A., Stechuchak, K. M., Coffman, C. J., Kappler, C. B., Meyer, C., Van Houtven, C. H., Allen, K. D., Hughes, J. M., Sperber, N., & Hastings, S. N. (2024). Organizational Characteristics of Hospitals Meeting STRIDE Program Adoption Benchmarks to Support Mobility for Hospitalized Persons. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61, 1–10. https://doi.org/10.1177/00469580241274030.
