Testing a theory of strategic implementation leadership, implementation climate, and clinicians' use of evidence-based practice: a 5-year panel analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101258411 Publication Model: Electronic Cited Medium: Internet ISSN: 1748-5908 (Electronic) Linking ISSN: 17485908 NLM ISO Abbreviation: Implement Sci Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Leadership* ; Organizational Culture*; Child Health Services/*organization & administration ; Community Mental Health Services/*organization & administration ; Evidence-Based Practice/*organization & administration; Adult ; Child ; Female ; Humans ; Implementation Science ; Male ; Mental Disorders/therapy ; Middle Aged ; Models, Econometric ; Organizational Innovation ; Psychotherapy/standards

Background: Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians' use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis.
Methods: Using data collected at three waves over a 5-year period from a panel of 30 outpatient children's mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians' use of EBP. At each wave, clinicians reported on their first-level leaders' implementation leadership, their organization's EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates.
Results: Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians' average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians' EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]).
Conclusions: When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership-EBP implementation climate mechanism.

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K23 MH099179 United States MH NIMH NIH HHS; P50MH113840 United States MH NIMH NIH HHS

Keywords: Behavioral health; Evidence-based practice; Implementation climate; Implementation leadership; Mechanism; Mediation

Date Created: 20200209 Date Completed: 20210202 Latest Revision: 20210202

20240829

PMC7006179

10.1186/s13012-020-0970-7

32033575