Introduction
Organizational citizenship behavior (OCB) has been defined as “individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system, and in the aggregate promotes the efficient and effective functioning of the organization” (p. 3) [
1]. OCB is related to a number of indicators of individual-level and unit-level effectiveness [
2-
4]. For instance, OCB is positively associated with managerial performance evaluations [
5,
6], actual performance [
7,
8], sales team effectiveness [
9], production quality [
10], and health care outcomes [
11-
14]. In addition, OCB has been shown to be negatively related to turnover and intentions to quit [
4].
Recently, OCB research has moved to take on a specific focus, such as customer-focused OCB and safety OCB, and to demonstrate relationships with outcomes of the same focus. For example, in the service literature, bank branch-level extra-role customer service behaviors (i.e., customer-focused OCB) have been shown to be positively related to customer satisfaction [
15,
16]. There has also been an increased interest in research on safety-specific OCB and its influence on safety-specific organizational outcomes. Griffin and Neal [
17] argued that safety-focused OCB was a distinct form of safety performance that captured employees’ voluntary participation in safety activities that “help to develop an environment that supports safety” (p. 349). Safety-focused citizenshipbehavior includes such activities as voluntarily participating in safety meetings [
17], promoting safety programs within the organization [
18], and raising safety concerns [
19].
This paper extends research on focused OCB to evidence-based practice (EBP) implementation. In health and mental health settings, there has been increasing attention to the development and use of EBPs with rigorous empirical support for their efficacy and effectiveness that also allow for clinical expertise and patient preference [
20]. In the United States, the use of such EBPs has been more commonly tied to federal and state funding as policy makers work to ensure that their financial support is being used in ways that will maximize the likelihood for more positive patient outcomes and public health impact [
21,
22]. One of the biggest challenges to the widespread application of EBPs is effective implementation, and one of the biggest challenges to effective implementation is the organizational context in which the implementation takes place [
23,
24]. Implementation researchers have developed a number of measures intended to capture the issues specifically relevant to implementation in health and allied health care settings (e.g., implementation leadership [
25], implementation climate [
26,
27], and molar climate, or general organizational social context [
28]). However, this research has not been extended to the actual focused behaviors performed by employees during the implementation process, specifically in the form of implementation citizenship behavior (ICB).
The goal of the present study was to address this gap in the literature through the development of an ICB scale (ICBS) designed to measure behaviors as they specifically relate to EBP implementation and associated outcomes. We define ICB as the discretionary behavior employees perform to support EBP implementation. Examples of such behaviors may include demonstrating a commitment to EBP, supporting the use and integration of EBP into clinical care, and holding others in the organization or team to the highest standards of EBP. There is very little literature on the behaviors that direct service health care providers perform to facilitate implementation, as much of the focus is on formal leaders [
23], opinion leaders [
29], champions [
30], or change agents [
31]. One exception can be found in Damschroder et al.’s [
32] Consolidated Framework for Implementation Research (CFIR). One of the major domains in the CFIR is characteristics of individuals, which includes a set of constructs that includes OCB labeled as “individual identification with the organization”. In describing these constructs, Damschroder et al. [
32] note, “These measures have been studied very little in healthcare, but may be especially important when evaluating the influence of implementation leaders… on implementation efforts” (p. 10). Thus, ICBs may play an important role for demonstrating employee engagement in the implementation process and for exhibiting positive peer influence towards EBP implementation and use.
We developed the ICBS based on past research on focused OCB, capturing two dimensions (helping behaviors and keeping informed) that were considered to be the most relevant for EBP implementation and that captured ICB targeted towards other individuals and ICB towards the organization as a whole, in line with how this distinction has been made in the OCB literature [
33]. We evaluated the ICB’s scale characteristics through an examination of factor structure and internal consistency reliabilities. In addition, we examined evidence for the construct validity of the scale through the inclusion of a number of additional measures. Specifically, we included measures to support the convergent evidence of validity via significant correlations of varying strength. Based on past OCB research suggesting that supervisors take into account their subordinates’ OCBs when evaluating their performance [
4] and because of frameworks like the CFIR [
32] that identify implementation-oriented OCBs as critical for implementation effectiveness, we expected supervisor ratings of ICB to be strongly correlated with supervisors’ perceptions of the employees’ implementation success, as well as moderately correlated with employees’ ratings of their own implementation success. We expected employee attitudes about EBPs to have small-to-moderate correlations with supervisor ratings of ICB, in line with the literature on job attitudes and OCB [
34]. Finally, we expected employee experience in mental health and full-time status to have weak-to-moderate relationships with ICB. Past research indicates that individuals with more expertise and who are more accessible have more opportunities to help their coworkers [
35]; in addition, individuals with more experience and who have full-time status should have more resources available to them to keep informed on issues related to EBPs.
In summary, the goal of this study was to develop a scale measuring ICB directed towards other individuals (helping) and towards the organization as a whole (keeping informed) that was pragmatic and brief to allow for use of the scale in both research and applied settings.
Discussion
The purpose of this study was to develop a brief, practical, reliable, and valid measure of implementation-focused citizenship behavior. Drawing from research on extant literature on OCB [
1,
33,
37] and with the input of subject matter experts in the domain of EBP implementation, we developed items capturing citizenship behaviors targeted towards other individuals (i.e., helping others) and towards the organization as a whole (i.e., keeping informed). Our analytic approach allowed us to reduce the number of items tapping these dimensions to three items each for a total of six items. This is consistent with emerging measurement work in implementation science that seeks to develop robust and pragmatic measures that can be efficiently used for research and for implementation process support [
25-
27]. Confirmatory factor analyses provided strong support for the overall structure of the scale, including strong factor loadings and overall fit. In line with these results, the internal consistency reliabilities for the overall scale and its two dimensions were strong.
There was also strong support for the construct validity of the ICBS. Clearly, supervisors see a close relationship with their employees’ implementation success and ICB, with correlations in the .72 to .81 range. Perhaps more interesting were the correlations between the providers’ ratings of their own implementation fidelity and the supervisor ratings of ICB, as these provide additional support for the association between implementation success and ICB using two different sources. The findings for employee attitudes were in line with expectations, although perhaps weaker than expected. That being said, one of the two scales that was not related to ICB was the Requirements subscale, which asks about willingness to adopt an EBP if required to do so and thus is not in line with the idea of OCB as behavior that goes beyond typical requirements. In that regard, this finding does make sense. In addition, ICB was not related to the Divergence subscale, which captures perceived divergence between EBPs and usual care. This is in contrast to the two subscales that were related to ICB, Appeal, and Openness, which capture positive attitudes towards EBPs. Thus, ICB was most closely related to positive attitudes about EBP. Nevertheless, the strength of the significant correlations (.12–.14) was lower than what Organ and Ryan [
34] found for attitudes predicting OCB (.19–.23 uncorrected). Future research should further investigate possible moderators that may affect the strength of this relationship. Finally, the ICBS was related to both experience (with Helping Others) and full-time status (with the total score and Helping Others subscale). Although these relationships were tested for measure validation purposes in this manuscript, they do provide a basis for future research to expand on to further clarify the mechanisms through which those with more experience and who work full-time have more opportunities to help their coworkers with implementation-related activities.
One consistent finding throughout the construct validity results was that the correlations were typically stronger for the Helping Others subscale than for the Keeping Informed subscale. A possible explanation for this finding is that supervisors are less aware of employees’ actions to stay informed about EBP, whereas employees’ helping their coworkers with implementation are more public and thus supervisor ratings are more accurate with regard to that dimension. It may also be the case that the variables included in the construct validity analyses tapped issues that were more relevant for Helping Others than for Keeping Informed. Future research should expand the nomological network of these dimensions to better understand their unique correlates. One such variable is the sex of the participant, as helping behavior is traditionally more associated with females than males [
47]. Post hoc exploratory analyses revealed no such difference in this sample; however, women were rated higher in keeping informed than men (
M (women) = 2.28,
M (men) = 1.86, t (290) = 2.72,
p < .01). Future research should explore the role of employees’ sex and gender in implementation citizenship behavior. In addition, future research should include providers’ self-ratings of their ICB to see how this affects the pattern of relationships with related constructs, as well as providers’ role definitions, as past research has shown that how broadly employees define the behaviors included in their work role has important implications for their likelihood of performing citizenship behavior [
48,
49].
One potential limitation of the present study is that it utilized a sample in the allied health care setting of mental health agencies. Future research should explore the ICBS’s utility in other settings in which implementation of EBP is a strategic imperative. Because our study focused on organizations that used multiple forms of EBP, we generalized the item wording when describing EBP. Even if the wording were adapted to fit a specific EBP, we would anticipate that the scale would remain meaningful and empirically supported; however, more research is needed to see if a focus on specific EBPs would impact the strength of the correlations. Another potential limitation is the sample size for the EFA, which consisted of 178 providers rated by 34 supervisors. However, past research on the appropriate sample size for factor analysis indicates that such sample sizes may be appropriate when communalities are high and the factors are overdetermined [
50]. Because our findings met these criteria and were also validated in the CFA, we concluded that the sample size was adequate for a stable solution. Finally, the importance of ICB is its impact on implementation and implementation-related outcomes; thus, future research should include a broader range of effectiveness variables, particularly those directly related client/patient outcomes.
Competing interests
GAA is an Associate Editor of “Implementation Science”; all decisions on this paper were made by another editor. The authors declare that they have no other competing interests.
Authors’ contributions
MGE and GAA were study principal investigators and contributed to the theoretical background and conceptualization of the study, item development, study design, writing, data analysis, and editing. LRF contributed to the item development, study design, data collection, writing, and editing. All authors read and approved the final manuscript.