Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

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

Authors: Gregory A Aarons, Mark G Ehrhart, Lauren R Farahnak, Michael S Hurlburt

Published in: Implementation Science | Issue 1/2015

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Institute of Medicine [IOM]. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
2.
American Psychological Association. Report of the 2005 Presidential Task Force on evidence-based practice. Washington, DC: American Psychological Association; 2005. p. 1–28.
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.CrossRef
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.CrossRef
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.CrossRef
6.
Gumusluoglu L, Ilsev A. Transformational leadership, creativity, and organizational innovation. J Bus Res. 2009;62:461–73.CrossRef
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.CrossRef
8.
Priestland A, Hanig R. Developing first-level leaders. Harv Bus Rev. 2005;83:112–20.PubMed
9.
Schein E. Organizational Culture and Leadership. San Francisco, CA: John Wiley and Sons; 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.CrossRefPubMed
11.
De Hoogh AHB, Den Hartog DN, Koopman PL, Thierry H, Van Den Berg PT, Van Der Weide JG, et al. Leader motives, charismatic leadership, and subordinates’ work attitude in the profit and voluntary sector. Leadership Quart. 2005;16:17–38.CrossRef
12.
Riggio RE, Bass BM, Orr SS. Transformational leadership in nonprofit organizations. In: Riggio RE, Orr SS, editors. Improving Leadership in Nonprofit Organizations. San Francisco, CA: Jossey-Bass; 2004. p. 49–62.
13.
Bass BM, Riggio RE. The development of transformational leadership. In: Bass BM, Riggio RE, editors. Transformational Leadership. 2nd ed. Mahwah, NJ: Lawrence Erlbaulm Associates, Inc; 2006. p. 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.CrossRefPubMed
15.
Glisson C, Durick M. Predictors of job satisfaction and organizational commitment in human service organizations. Admin Sci Quart. 1988;33:61–81.CrossRef
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.CrossRefPubMed
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.CrossRefPubMed
18.
19.
Aarons GA, Horowitz JD, Dlugosz LR, Ehrhart MG. The role of organizational processes in dissemination and implementation research. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and Implementation Research in Health: Translating Science to Practice. New York, NY: Oxford University Press; 2012.
20.
Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, et al. 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.CrossRefPubMedPubMedCentral
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.CrossRef
22.
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.CrossRef
24.
Edmondson A. Psychological safety and learning behavior in work teams. Admin Sci Quart. 1999;44:350–83.CrossRef
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.CrossRef
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, et al. 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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
32.
Avolio BJ, Bass BM. The Full Range of Leadership Development: Basic and Advanced Manuals. Binghamton, NY: Bass, Avolio, & Associates; 1991.
33.
Bass BM, Avolio BJ. Training Full Range Leadership. Redwood City, CA: Mind Garden, Inc.; 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.CrossRef
35.
Bass BM. Does the transactional-transformational leadership paradigm transcend organizational and national boundaries. Am Psychol. 1997;52:130–9.CrossRef
36.
Bass BM, Avolio BJ. The implications of transformational and transactional leadership for individual, team, and organizational development. In: Pasmore W, Woodman RW, editors. Research in Organizational Change and Development. Greenwich, CT: JAI Press; 1990. p. 231–72.
37.
Bass BM. Two decades of research and development in transformational leadership. Eur J Work Organ Psy. 1999;8:9–32.CrossRef
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.CrossRefPubMedPubMedCentral
39.
Edmondson AC. Framing for learning: lessons in successful technology implementation. Calif Manage Rev. 2003;45:35–54.CrossRef
40.
Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: team learning and new technology implementation in hospitals. Admin Sci Quart. 2001;46:685–716.CrossRef
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.CrossRef
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.CrossRef
43.
Jeffs L, Sidani S, Rose D, Espin S, Smith O, Martin K, et al. 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.CrossRefPubMed
44.
Rycroft-Malone J, Wilkinson J, Burton CR, Harvey G, McCormack B, Graham I, et al. 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.CrossRefPubMed
45.
Ullrich PM, Sahay A, Stetler CB. Use of implementation theory: a focus on PARIHS. Worldviews Evid-Based Nurs. 2013;11:26–34.CrossRefPubMed
46.
Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, et al. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010;5:82.CrossRefPubMedPubMedCentral
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.CrossRefPubMedPubMedCentral
48.
Nutt PC, Backoff RW. Facilitating transformational change. J Appl Behav Sci. 1997;33:490–508.CrossRef
49.
Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45:626–9.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
51.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. 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.CrossRefPubMed
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.CrossRef
53.
Nunnally JC, Bernstein IH. Psychometric Theory. New York, NY: McGraw-Hill; 1994.
54.
55.
Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141:2.CrossRefPubMed
56.
Raudenbush SW, Bryk AS. Hierarchical Linear Models: Applications and Data Analysis Methods. Thousand Oaks, CA: Sage Publications; 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. Doncaster, Victoria, AU: QSR International; 2012.
59.
Patton MQ. Qualitative analysis and interpretation. In: Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2002. p. 431–539.
60.
Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks, CA: Sage Publications, Inc; 1998.
61.
Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage Publications, Inc.; 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.CrossRefPubMed
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.CrossRef
64.
Harrison R. Choosing the depth of organizational intervention. J Appl Behav Sci. 1970;6:181–202.CrossRef
65.
Reiter-Palmon R, Illies JJ. Leadership and creativity: understanding leadership from a creative problem-solving perspective. Leadership Quart. 2004;15:55–77.CrossRef
66.
Kouzes JM, Posner BZ. The leadership challenge. 5th ed. San Francisco, CA: John Wiley & Sons; 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.CrossRef
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.CrossRef
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, et al. Barriers to evidence-based practice implementation: results of a qualitative study. Community Ment Health J. 2010;46:112–8.CrossRefPubMed
71.
Glisson C, Schoenwald SK, Hemmelgarn A, Green P, Dukes D, Armstrong KS, et al. Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. J Consult Clin Psychol. 2010;78:537–50.CrossRefPubMedPubMedCentral
72.
Schneider B, Ehrhart MG, Macey WA. Organizational climate and culture. Annu Rev Psychol. 2013;64:361–88.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
76.
Sosik JJ, Jung DI, Jung DD. Full range leadership development. New York, NY: Taylor & Francis Group; 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.CrossRef
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMedPubMedCentral
Metadata
Title
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
Authors
Gregory A Aarons
Mark G Ehrhart
Lauren R Farahnak
Michael S Hurlburt
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-014-0192-y

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Research

A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

Study protocol

A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs

Erratum

Erratum to: Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

Study protocol

Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients—the INDICA study: a cluster randomized controlled trial

Research

Going above and beyond for implementation: the development and validity testing of the Implementation Citizenship Behavior Scale (ICBS)

Research

Implementation of secondary fracture prevention services after hip fracture: a qualitative study using extended Normalization Process Theory