Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation

Implementation Science

Michael S Hurlburt³  Lauren R Farahnak¹  Mark G Ehrhart²  Gregory A Aarons² 

[1] Child and Adolescent Services Research Center, San Diego, CA, USA;Center for Organizational Research on Implementation and Leadership, San Diego, CA, USA;School of Social Work, University of Southern California, Los Angeles, CA, USA

关键词: Organizational climate;    Organizational culture;    Organizational development;    Evidence-based practice;    Organization;    Leadership;   

Others  :  1139380
DOI  :  10.1186/s13012-014-0192-y

 received in 2013-08-27, accepted in 2014-12-10,  发布年份 2015

【 摘 要 】

Background

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs.

Methods

Participants were 12 mental health service team leaders and their staff (n = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees.

Results

Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes.

Conclusions

The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

【 授权许可】

   
2015 Aarons et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Institute of Medicine [IOM]: Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Washington, DC; 2001.
• [2]American Psychological Association: Report of the 2005 Presidential Task Force on evidence-based practice. American Psychological Association, Washington, DC; 2005.
• [3]Aarons GA, Hurlburt M, Horwitz SM: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Hlth 2011, 38:4-23.
• [4]Damanpour F, Schneider M: Phases of the adoption of innovation in organizations: effects of environment, organization and top managers. Brit J Manage 2006, 17:215-36.
• [5]Jung DI, Chow C, Wu A: The role of transformational leadership in enhancing organizational innovation: hypotheses and some preliminary findings. Leadership Quart 2003, 14:525-44.
• [6]Gumusluoglu L, Ilsev A: Transformational leadership, creativity, and organizational innovation. J Bus Res 2009, 62:461-73.
• [7]Scott SG, Bruce RA: Determinants of innovative behavior: a path model of individual innovation in the workplace. Acad Manage J 1994, 37:580-607.
• [8]Priestland A, Hanig R: Developing first-level leaders. Harv Bus Rev 2005, 83:112-20.
• [9]Schein E: Organizational Culture and Leadership. John Wiley and Sons, San Francisco, CA; 2010.
• [10]Corrigan PW, Lickey SE, Campion J, Rashid F: Mental health team leadership and consumers’ satisfaction and quality of life. Psychiatr Serv 2000, 51:781-5.
• [11]De Hoogh AHB, Den Hartog DN, Koopman PL, Thierry H, Van Den Berg PT, Van Der Weide JG, Wilderom CPM: Leader motives, charismatic leadership, and subordinates’ work attitude in the profit and voluntary sector. Leadership Quart 2005, 16:17-38.
• [12]Riggio RE, Bass BM, Orr SS: Transformational leadership in nonprofit organizations. In Improving Leadership in Nonprofit Organizations. Edited by Riggio RE, Orr SS. Jossey-Bass, San Francisco, CA; 2004:49-62.
• [13]Bass BM, Riggio RE: The development of transformational leadership. In Transformational Leadership. 2nd edition. Edited by Bass BM, Riggio RE. Lawrence Erlbaulm Associates, Inc, Mahwah, NJ; 2006:142-66.
• [14]Judge TA, Piccolo RF: Transformational and transactional leadership: a meta-analytic test of their relative validity. J Appl Psychol 2004, 89:755-68.
• [15]Glisson C, Durick M: Predictors of job satisfaction and organizational commitment in human service organizations. Admin Sci Quart 1988, 33:61-81.
• [16]Green AE, Albanese BJ, Cafri G, Aarons GA: Leadership, organizational climate, and working alliance in a children’s mental health service system. Community Ment Health J 2014, 50:771-7.
• [17]Henderson A, Paterson K, Burmeister L, Thomson B, Young L: Staff perceptions of leadership during implementation of task‐shifting in three surgical units. J Nurs Manag 2013, 21:368-76.
• [18]Aarons GA: Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatr Serv 2006, 57:1162-9.
• [19]Aarons GA, Horowitz JD, Dlugosz LR, Ehrhart MG: The role of organizational processes in dissemination and implementation research. In Dissemination and Implementation Research in Health: Translating Science to Practice. Edited by Brownson RC, Colditz GA, Proctor EK. Oxford University Press, New York, NY; 2012.
• [20]Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, Kislov R, Boaden R: The NIHR collaboration for leadership in applied health research and care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci 2011, 6:96. BioMed Central Full Text
• [21]Kyratsis Y, Ahmad R, Holmes A: Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. Stud Protocol Implement Sci 2012, 7:22. BioMed Central Full Text
• [22]Weiner BJ: A theory of organizational readiness for change. Implement Sci 2009, 4:67. BioMed Central Full Text
• [23]Edmondson AC: Speaking up in the operating room: how team leaders promote learning in interdisciplinary action teams. J Manage Stud 2003, 40:1419-52.
• [24]Edmondson A: Psychological safety and learning behavior in work teams. Admin Sci Quart 1999, 44:350-83.
• [25]Nembhard IM, Edmondson AC: Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav 2006, 27:941-66.
• [26]Rokstad AMM, Vatne S, Engedal K, Selbæk G. The role of leadership in the implementation of person‐centred care using Dementia Care Mapping: a study in three nursing homes. J Nurs Manag. 2013. DOI: 10.1111/jonm.12072
• [27]Touveneau S, Clack L, Ginet C, Stewardson A, Schindler M, Bourrier M, Pittet D, Sax H: P168: Leadership styles of ward head nurses and implementation success–a qualitative inquiry in the framework of a mixed-method study on hand hygiene promotion through patient involvement. Antimicrobial Resistance and Infection Control 2013, 2(suppl 1):168. BioMed Central Full Text
• [28]Aarons GA, Sommerfeld DH: Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation. J Am Acad Child Psy 2012, 51:423-31.
• [29]Sandström B, Borglin G, Nilsson R, Willman A: Promoting the implementation of evidence-based practice: a literature review focusing on the role of nursing leadership. Worldv Evid-Based Nu 2011, 8:212-23.
• [30]Gifford WA, Davies B, Edwards N, Graham ID: Leadership strategies to influence the use of clinical practice guidelines. Nurs Leadersh 2006, 19:72-88.
• [31]Gifford WA, Davies BL, Graham ID, Tourangeau A, Woodend AK, Lefebre N: Developing leadership capacity for guideline use: a pilot cluster randomized control trial. Worldv Evid-Based Nu 2012, 10:51-65.
• [32]Avolio BJ, Bass BM: The Full Range of Leadership Development: Basic and Advanced Manuals. Bass, Avolio, & Associates, Binghamton, NY; 1991.
• [33]Bass BM, Avolio BJ: Training Full Range Leadership. Mind Garden, Inc., Redwood City, CA; 1999.
• [34]Avolio BJ, Bass BM, Jung DI: Re-examining the components of transformational and transactional leadership using the Multifactor Leadership Questionnaire. J Occup Organ Psychol 1999, 72:441-62.
• [35]Bass BM: Does the transactional-transformational leadership paradigm transcend organizational and national boundaries. Am Psychol 1997, 52:130-9.
• [36]Bass BM, Avolio BJ: The implications of transformational and transactional leadership for individual, team, and organizational development. In Research in Organizational Change and Development. Edited by Pasmore W, Woodman RW. JAI Press, Greenwich, CT; 1990:231-72.
• [37]Bass BM: Two decades of research and development in transformational leadership. Eur J Work Organ Psy 1999, 8:9-32.
• [38]Aarons GA, Ehrhart MG, Farahnak LR: The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership. Implement Sci 2014, 9:45. BioMed Central Full Text
• [39]Edmondson AC: Framing for learning: lessons in successful technology implementation. Calif Manage Rev 2003, 45:35-54.
• [40]Edmondson AC, Bohmer RM, Pisano GP: Disrupted routines: team learning and new technology implementation in hospitals. Admin Sci Quart 2001, 46:685-716.
• [41]Parry KW, Proctor-Thomson SB: Leadership, culture and performance: the case of the New Zealand public sector. J Change Manage 2003, 3:376-99.
• [42]Schuller KA, Kash BA, Edwardson N, Gamm LD: Enabling and disabling factors in implementation of Studer group’s evidence-based leadership initiative: a qualitative case study. J Commun Healthcare 2013, 6:90-9.
• [43]Jeffs L, Sidani S, Rose D, Espin S, Smith O, Martin K, Byer C, Fu K, Ferris E: Using theory and evidence to drive measurement of patient, nurse and organizational outcomes of professional nursing practice. Int J Nurs Pract 2013, 19:141-8.
• [44]Rycroft-Malone J, Wilkinson J, Burton CR, Harvey G, McCormack B, Graham I, Staniszewska S: Collaborative action around implementation in collaborations for leadership in applied health research and care: towards a programme theory. J Health Serv Res Policy 2013, 18(3 suppl):13-26.
• [45]Ullrich PM, Sahay A, Stetler CB: Use of implementation theory: a focus on PARIHS. Worldviews Evid-Based Nurs 2013, 11:26-34.
• [46]Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci 2010, 5:82. BioMed Central Full Text
• [47]Aarons GA, Ehrhart MG, Farahnak LR, Sklar M: Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annu Rev Public Health 2014, 35:255-74.
• [48]Nutt PC, Backoff RW: Facilitating transformational change. J Appl Behav Sci 1997, 33:490-508.
• [49]Leon AC, Davis LL, Kraemer HC: The role and interpretation of pilot studies in clinical research. J Psychiatr Res 2011, 45:626-9.
• [50]Eccles M, Grimshaw J, Campbell M, Ramsay C: Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 2003, 12:47-52.
• [51]Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE: The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013, 46:81-95.
• [52]Carifio J, Perla RJ: Ten common misunderstandings, misconceptions, persistent myths and urban legends about Likert scales and Likert response formats and their antidotes. J Soc Sci 2007, 3:106.
• [53]Nunnally JC, Bernstein IH: Psychometric Theory. McGraw-Hill, New York, NY; 1994.
• [54]Cohen J: A power primer. Psychol Bull 1992, 112:155-9.
• [55]Fritz CO, Morris PE, Richler JJ: Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012, 141:2.
• [56]Raudenbush SW, Bryk AS: Hierarchical Linear Models: Applications and Data Analysis Methods. Sage Publications, Thousand Oaks, CA; 2002.
• [57]Muthén LK, Muthén BO. Mplus user’s Guide. 7th edition. Los Angeles, CA: Muthén & Muthén; 1998–2012.
• [58]QSR International Pty Ltd: NVivo 10 for Windows. QSR International, Doncaster, Victoria, AU; 2012.
• [59]Patton MQ: Qualitative analysis and interpretation. In Qualitative Research and Evaluation Methods. 3rd edition. Sage Publications, Thousand Oaks, CA; 2002:431-539.
• [60]Corbin J, Strauss A: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd edition. Sage Publications, Inc, Thousand Oaks, CA; 1998.
• [61]Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. Sage Publications, Inc., Thousand Oaks, CA; 1994.
• [62]Aarons GA, Fettes DL, Sommerfeld DH, Palinkas LA: Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services. Child Maltreatment 2012, 17:67-79.
• [63]Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J: Mixed method designs in implementation research. Adm Policy Ment Hlth 2011, 38:44-53.
• [64]Harrison R: Choosing the depth of organizational intervention. J Appl Behav Sci 1970, 6:181-202.
• [65]Reiter-Palmon R, Illies JJ: Leadership and creativity: understanding leadership from a creative problem-solving perspective. Leadership Quart 2004, 15:55-77.
• [66]Kouzes JM, Posner BZ: The leadership challenge. 5th edition. John Wiley & Sons, San Francisco, CA; 2012.
• [67]Van Knippenberg D, Sitkin S: A critical assessment of charismatic-transformational leadership research: back to the drawing board? Acad Manage Annals 2013, 7:1-60.
• [68]Barling J, Weber TJ, Kelloway EK: Effects of transformational leadership training on attitudinal and financial outcomes: a field experiment. J Appl Psychol 1996, 81:827-32.
• [69]Pasmore WA, Fagans MR: Participation, individual development, and organizational change: a review and synthesis. J Air Waste Manage Assoc 1992, 18:375-97.
• [70]Rapp CA, Etzel-Wise D, Marty D, Coffman M, Carlson L, Asher D, Callaghan J, Holter M: Barriers to evidence-based practice implementation: results of a qualitative study. Community Ment Health J 2010, 46:112-8.
• [71]Glisson C, Schoenwald SK, Hemmelgarn A, Green P, Dukes D, Armstrong KS, Chapman JE: Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. J Consult Clin Psychol 2010, 78:537-50.
• [72]Schneider B, Ehrhart MG, Macey WA: Organizational climate and culture. Annu Rev Psychol 2013, 64:361-88.
• [73]Aarons, GA, Ehrhart, MG, Farahnak, LR, & Finn, N. Implementation Leadership: Confirmatory Factor Analysis and Supervisor-Clinician Discrepancy in Ratings on the Implementation Leadership Scale (ILS). Paper presented at the 7th Annual Conference on the Science of Dissemination and Implementation. Bethesda, MD; December, 2014.
• [74]Klein KJ, Conn AB, Smith DB, Sorra JS: Is everyone in agreement? An exploration of within-group agreement in employee perceptions of the work environment. J Appl Psychol 2001, 86:3-16.
• [75]Bass BM, Avolio BJ, Jung DI, Berson Y: Predicting unit performance by assessing transformational and transactional leadership. J Appl Psychol 2003, 88:207-18.
• [76]Sosik JJ, Jung DI, Jung DD: Full range leadership development. Taylor & Francis Group, New York, NY; 2012.
• [77]Conger JA, Fishel B: Accelerating leadership performance at the top: Lessons from the Bank of America’s executive on-boarding process. Hum Resour Manage R 2007, 17:442-54.
• [78]Ehrhart MG, Aarons GA, Farahnak LR: Assessing the Organizational Context for EBP Implementation: The Development and Validity Testing of the Implementation Climate Scale (ICS). Implement Sci 2014, 9:157. BioMed Central Full Text
• [79]Gifford WA, Davies B, Graham ID, Lefebre N, Tourangeau A, Woodend AK: A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing. Implement Sci 2008, 3:51. BioMed Central Full Text