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Kitson AL, Harvey G, Gifford W, Hunter SC, Kelly J, Cummings GG, Ehrenberg A, Kislov R, Pettersson L, Wallin L, Wilson P. How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study. J Adv Nurs 2021; 77:2447-2457. [PMID: 33626205 DOI: 10.1111/jan.14773] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
AIMS To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. DESIGN A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. METHODS Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. RESULTS Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. CONCLUSION The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. IMPACT This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.
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Affiliation(s)
- Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Wendy Gifford
- Faculty of Heaslth Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | | | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University and School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lena Pettersson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paul Wilson
- Schoolf of Health Sciences, The University of Manchester, Manchester, UK
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Determinants of using children's mental health research in policymaking: variation by type of research use and phase of policy process. Implement Sci 2021; 16:13. [PMID: 33468166 PMCID: PMC7815190 DOI: 10.1186/s13012-021-01081-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 01/24/2023] Open
Abstract
Background Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking. Methods A web-based survey of US state agency officials involved with children’s mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children’s mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores. Results Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (β = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (β = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (β = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (β = −0.21, p = 0.01) and instrumental (β = −0.22, p = 0.01) research use and during all three phases of policy process. Conclusions Decisions about the determinants to target with policy-focused implementation strategies—and the strategies that are selected to affect these targets—should reflect the specific types of research use that these strategies aim to influence. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01081-8.
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Puchalski Ritchie LM, Mundeva H, van Lettow M, Straus SE, Kip E, Makwakwa A. Impact of peer-trainer leadership style on uptake of a peer led educational outreach intervention to improve tuberculosis care and outcomes in Malawi: a qualitative study. BMC Health Serv Res 2020; 20:513. [PMID: 32503525 PMCID: PMC7275352 DOI: 10.1186/s12913-020-05386-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about how to build leadership capacity to support implementation of evidence-based practices within health systems. We observed substantial variability across sites in uptake and sustainability of a peer-led educational outreach intervention for lay health workers (LHWs) providing tuberculosis care in Malawi. Feedback from peer-trainers (PTs) suggested that leadership may have contributed to the variation. We sought to assess the impact of PT leadership style on implementation, and to identify leadership traits of more successful PTs, to inform future implementation planning and to identify targets for leadership capacity building. Methods Qualitative study employing interviews with PTs and LHWs at high and low implementation sites, and review of study team and quarterly PT meeting notes. High implementation sites achieved high uptake, sustainability and fidelity of implementation including: close adherence to training content and process, high levels of coverage (training most or all eligible LHWs at their site), and outcomes were achieved with high levels of self reported competence with the intervention among both PTs and LHWs. Low implementation sites achieved limited coverage (<= 50% of LHWs trained), and intervention fidelity. Results Eight PTs and 10 LHWs from eight high and 10 low implementation sites participated in interviews. Leadership traits of more successful PTs included: flexibility in their approach to training, role modeling and provision of supportive supervision to support learning; addressing challenges proactively and as they occurred; collaborative planning; knowledgeable; and availability to support implementation. Traits unique to less successful PTs included: a poor attitude toward their role as PT and a passive-avoidant approach to challenges. Conclusion This study identified leadership traits more common among unit level leaders at sites with higher uptake, sustainability, and fidelity of implementation. These findings provide a starting point for development and evaluation of a leadership capacity building intervention for unit level leaders to support implementation.
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Affiliation(s)
- L M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Canada. .,Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michaels Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Emergency Medicine, University Health Network, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - H Mundeva
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michaels Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S E Straus
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Emergency Medicine, University Health Network, Toronto, Canada
| | - E Kip
- Dignitas International, Zomba, Malawi
| | - A Makwakwa
- National TB Program, Ministry of Health, PO Box 30377, Lilongwe, Malawi
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Rethlefsen SA, Bent MA, Mueske NM, Wren TAL. Relationships among classifications of impairment and measures of ambulatory function for children with spina bifida. Disabil Rehabil 2020; 43:3696-3700. [PMID: 32255380 DOI: 10.1080/09638288.2020.1746845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity.Materials and methods: A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)]. Daily walking activity was measured with a StepWatch monitor. Data were analyzed using Spearman rank correlation.Results: Sixty-one children were included, [56% male, average age 9.8 (SD 2.7) years]. The neurosegmental level classifications, X-ray lesion level and IMSG level showed little to no correlation with each other (r = 0.17). Among functional classifications, the Dias FCM correlated strongly with the FMS (r = 0.80-0.87). Correlations with steps per day were moderate to good for the Dias FCM and the FMS (r = 0.53-0.62), fair for IMSG level (r = 0.45), and little to none for X-ray lesion level (r = 0.03).Conclusions: The Dias FCM is comprehensive, including elements of neurosegmental level and function, and correlates well with walking activity. We recommend its use for classifying function in patients with Spina Bifida.Implications for rehabilitationFunctional classifications correlate better with daily walking activity than neurosegmental level classifications for patients with Spina Bifida.The Dias FCM includes neurosegmental and functional level elements, correlates well with daily activity, and is recommended for use in classifying Spina Bifida patients.Combined use of the FMS and activity monitoring is recommended for research and clinical assessment.
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Affiliation(s)
- Susan A Rethlefsen
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa A Bent
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicole M Mueske
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tishya A L Wren
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Bredella MA, Fessell D, Thrall JH. Mentorship in academic radiology: why it matters. Insights Imaging 2019; 10:107. [PMID: 31728762 PMCID: PMC6856244 DOI: 10.1186/s13244-019-0799-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023] Open
Abstract
Mentorship plays a critical role in the success of academic radiologists. Faculty members with mentors have better career opportunities, publish more papers, receive more research grants, and have greater overall career satisfaction. However, with the increasing focus on clinical productivity, pressure on turn-around times, and the difficult funding climate, effective mentoring in academic radiology can be challenging. The high prevalence of “burnout” among radiologists makes mentorship even more important. This article reviews benefits and challenges of mentorship in academic radiology, discusses how to institute a faculty mentoring program, examines different types of mentoring, and reviews challenges related to diversity and inclusion.
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Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
| | - David Fessell
- Musculoskeletal Division, Taubman Center, University of Michigan, Room 2910K, 1500 E Medical Center Drive, SPC 5326, Ann Arbor, MI, 48109, USA
| | - James H Thrall
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
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Ganann R, Weeres A, Lam A, Chung H, Valaitis R. Optimization of home care nurses in Canada: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e604-e621. [PMID: 31231890 PMCID: PMC6851676 DOI: 10.1111/hsc.12797] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 05/04/2023]
Abstract
Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra-professional and Inter-professional and Inter-sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter-related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra- and inter-professional and inter-organisational contexts.
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Affiliation(s)
- Rebecca Ganann
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Annette Weeres
- Registered Practical Nurses Association of OntarioMississaugaOntarioCanada
| | - Annie Lam
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Harjit Chung
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Ruta Valaitis
- School of Nursing, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
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Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, Laeuchli S, Mosti G, Probst S, Weller C. Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice. J Wound Care 2018; 25 Suppl 6:S1-S67. [PMID: 27292202 DOI: 10.12968/jowc.2016.25.sup6.s1] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).
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Affiliation(s)
- Peter J Franks
- Centre for Research & Implementation of Clinical Practice, 128 Hill House, 210 Upper Richmond Road, London SW15 6NP, United Kingdom
| | | | - Mark Collier
- United Lincolnshire Hospitals NHS Trust (ULHT), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9QS, United Kingdom
| | | | - Emily Haesler
- Wound Management and Healing Node, Curtin University, Perth, Australia & Academic Unit of General Practice, Australian National University, Canberra, Australia (Visiting Fellow)
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | - Severin Laeuchli
- University Hospital Zürich, Department of Dermatology, Gloriastrasse 31, CH-8091 Zürich, Switzerland
| | | | - Sebastian Probst
- School of Health, University of Applied Sciences Western Switzerland, HES-SO Genève, Avenue de Champel 47, CH-1206 Geneva, Switzerland
| | - Carolina Weller
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
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8
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Zecevic AA, Li AHT, Ngo C, Halligan M, Kothari A. Improving safety culture in hospitals: Facilitators and barriers to implementation of Systemic Falls Investigative Method (SFIM). Int J Qual Health Care 2017; 29:371-377. [PMID: 28340250 DOI: 10.1093/intqhc/mzx034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. Design A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. Setting A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls. Participants Hospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management. Intervention Implementation of the SFIM to investigate fall occurrences. Main Outcome Measure(s) Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation. Results Both hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication. Conclusions Successful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly.
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Affiliation(s)
| | - Alvin Ho-Ting Li
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Charity Ngo
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Michelle Halligan
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Anita Kothari
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
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Lega F, Prenestini A, Rosso M. Leadership research in healthcare: A realist review. Health Serv Manage Res 2017; 30:94-104. [DOI: 10.1177/0951484817708915] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Being largely considered a human right, healthcare needs leaders who are able to make choices and to set directions. Following the recommendations expressed by Gilmartin and D'Aunno's review and roadmap compiled in 2008, today, it is important to acknowledge researchers' contributions to outline this landscape. The realist review of 77 publications answered questions such as “what works, for whom, and in which circumstances” highlighting: the effectiveness and acceptance of transformational and collaborative approaches; professionalism, expertise, and good task delegation within operational teams; distributed leadership, relationships, and social responsibility at a systemic level. The relevancy and need of leadership development programs, framed within a wider strategy, emerged. Nonetheless, gaps still exist and require further investigation: particular needs in public vs. private contexts; professionals' and women's differentiating characters; generational gaps; associations between leadership and recruitment HR practices research; how (and if) leaders (should) influence the organizational culture and values; and developing countries specific challenges. Also, a greater proportion of relevant findings should be drawn by empirical and more rigorous studies. Finally, a major attention could be paid to interactions happening at the team, organizational, and systemic level among different leaders and among leaders, followers and external actors.
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Affiliation(s)
- Federico Lega
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
- CeRGAS, SDA Bocconi – School of Management, Bocconi University, Milan, Italy
| | - Anna Prenestini
- CeRGAS, SDA Bocconi – School of Management, Bocconi University, Milan, Italy
| | - Matilde Rosso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Gifford W, Graham ID, Ehrhart MG, Davies BL, Aarons GA. Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory-based leadership interventions. J Healthc Leadersh 2017; 9:15-23. [PMID: 29355212 PMCID: PMC5774448 DOI: 10.2147/jhl.s125558] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions. Methods Modified template analysis was conducted to deductively map items of the ILS onto concepts of the O-MILe. An iterative process was used in which the model and scale developers (n=5) appraised the relevance, conceptual clarity, and fit of each ILS items with the O-MILe concepts through individual feedback and group discussions until consensus was reached. Results All 12 items of the ILS correspond to at least one O-MILe concept, demonstrating compatibility of the ILS as a measurement tool for the O-MILe theoretical constructs. Conclusion The O-MILe provides a theoretical basis for developing implementation leadership, and the ILS is a compatible tool for measuring leadership based on the O-MILe. Used together, the O-MILe and ILS provide an evidence- and theory-based approach for developing and measuring leadership for implementing evidence-based practices in health care. Template analysis offers a convenient approach for determining the compatibility of independently developed evaluation tools to test theoretical models.
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Affiliation(s)
- Wendy Gifford
- School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Ian D Graham
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute.,School of Epidemiology, Public Health and Preventive Medicine, Facility of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mark G Ehrhart
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Barbara L Davies
- Nursing Best Practice Research Center, University of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, University of California, San Diego, CA, USA
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11
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Richter A, von Thiele Schwarz U, Lornudd C, Lundmark R, Mosson R, Hasson H. iLead-a transformational leadership intervention to train healthcare managers' implementation leadership. Implement Sci 2016; 11:108. [PMID: 27473116 PMCID: PMC4966756 DOI: 10.1186/s13012-016-0475-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Leadership is a key feature in implementation efforts, which is highlighted in most implementation frameworks. However, in studying leadership and implementation, only few studies rely on established leadership theory, which makes it difficult to draw conclusions regarding what kinds of leadership managers should perform and under what circumstances. In industrial and organizational psychology, transformational leadership and contingent reward have been identified as effective leadership styles for facilitating change processes, and these styles map well onto the behaviors identified in implementation research. However, it has been questioned whether these general leadership styles are sufficient to foster specific results; it has therefore been suggested that the leadership should be specific to the domain of interest, e.g., implementation. To this end, an intervention specifically involving leadership, which we call implementation leadership, is developed and tested in this project. The aim of the intervention is to increase healthcare managers’ generic implementation leadership skills, which they can use for any implementation efforts in the future. Methods/design The intervention is conducted in healthcare in Stockholm County, Sweden, where first- and second-line managers were invited to participate. Two intervention groups are included, including 52 managers. Intervention group 1 consists of individual managers, and group 2 of managers from one division. A control group of 39 managers is additionally included. The intervention consists of five half-day workshops aiming at increasing the managers’ implementation leadership, which is the primary outcome of this intervention. The intervention will be evaluated through a mixed-methods approach. A pre- and post-design applying questionnaires at three time points (pre-, directly after the intervention, and 6 months post-intervention) will be used, in addition to process evaluation questionnaires related to each workshop. In addition, interviews will be conducted over time to evaluate the intervention. Discussion The proposed intervention represents a novel contribution to the implementation literature, being the first to focus on strengthening healthcare managers’ generic skills in implementation leadership.
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Affiliation(s)
- Anne Richter
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden. .,Unit for Implementation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, Sweden.
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Caroline Lornudd
- Unit for Implementation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, Sweden.,Leadership, Evaluation and Organizational Development Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Robert Lundmark
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Rebecca Mosson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Unit for Implementation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, Sweden
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Unit for Implementation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, Sweden
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Kc A, Wrammert J, Clark RB, Ewald U, Vitrakoti R, Chaudhary P, Pun A, Raaijmakers H, Målqvist M. Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe. Pediatrics 2016; 137:peds.2015-0117. [PMID: 27225317 DOI: 10.1542/peds.2015-0117] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. METHODS The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. RESULTS The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32-0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31-0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09-0.17) and 62% (OR 0.38, 95% CI 0.29-0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after. CONCLUSIONS The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.
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Affiliation(s)
- Ashish Kc
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; Health Section, UNICEF Nepal Country Office, UN House, Pulchowk, Lalitpur, Nepal;
| | - Johan Wrammert
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | | | - Uwe Ewald
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Ravi Vitrakoti
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Asha Pun
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Hendrikus Raaijmakers
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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13
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Aarons GA, Ehrhart MG, Farahnak LR, Hurlburt MS. 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. Implement Sci 2015; 10:11. [PMID: 25592163 PMCID: PMC4310135 DOI: 10.1186/s13012-014-0192-y] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/10/2014] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Gregory A Aarons
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- Center for Organizational Research on Implementation and Leadership, San Diego, CA, USA.
| | - Mark G Ehrhart
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Center for Organizational Research on Implementation and Leadership, San Diego, CA, USA.
| | - Lauren R Farahnak
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Michael S Hurlburt
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
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Wallin L, Boström AM, Gustavsson JP. Capability Beliefs Regarding Evidence-Based Practice are Associated with Application of EBP and Research Use: Validation of a New Measure. Worldviews Evid Based Nurs 2012; 9:139-48. [DOI: 10.1111/j.1741-6787.2012.00248.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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KITSON ALISON, SILVERSTON HEIDI, WIECHULA RICK, ZEITZ KATHRYN, MARCOIONNI DANNI, PAGE TAMMY. Clinical nursing leaders’, team members’ and service managers’ experiences of implementing evidence at a local level. J Nurs Manag 2011; 19:542-55. [DOI: 10.1111/j.1365-2834.2011.01258.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Forsner T, Wistedt AÅ, Brommels M, Janszky I, de Leon AP, Forsell Y. Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up. Implement Sci 2010; 5:4. [PMID: 20181013 PMCID: PMC2832625 DOI: 10.1186/1748-5908-5-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 01/26/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation. METHODS Six psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study. RESULTS The documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months. CONCLUSIONS Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.
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Affiliation(s)
- Tord Forsner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
| | - Anna Åberg Wistedt
- Department of Clinical Neuroscience, Section of Psychiatry St Göran's Hospital, Karolinska Institutet, Stockholm, SE-112 81, Sweden
| | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, SE- 171 77, Sweden
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
| | - Antonio Ponce de Leon
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
- Department of Epidemiology, Rio de Janeiro State University, Brazil
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
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