Advancing theory on the multilevel role of leadership in the implementation of evidence-based health care practices

Abstract

Our findings have implications for developing a multilevel leadership approach to implementation in health care. Leadership development should build on different competencies based on managers' level but align managers' priorities on the same implementation goals.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review

“…Leaders’ openness towards EBPs positively predicted implementation of medication-assisted treatment. * Guerrero et al 2020 [ 15 ] IL IC A Obs AH I IL was positively associated with provider's EBPA. IL did not mediate the relation among top leaders’ TfL and A.…”

“…Results from the qualitative synthesis are listed in Table 8 . Most studies (43%) examined the relationship between general leadership and an inner-context outcome [ 45 , 65 , 81 , 82 , 84 – 86 , 88 , 92 ], and fewer studies examined the relationship between strategic implementation leadership and an inner-context outcome (24%) [ 15 , 45 , 65 , 92 , 97 ].…”

“…While there is no universally adopted leadership definition, conceptualizations generally reflect a process of intentional efforts by an individual to motivate, influence, and enable a person or group of people with the aim of impacting group or organizational outcomes [ 11 – 13 ]. Leadership across organizational levels—from top leaders who establish organizational policies and practices [ 14 ] to first-level leaders who directly supervise employees providing direct services—and their alignment with one another influence the success of implementation [ 15 , 16 ]. Achieving organizational effectiveness, including effectiveness in EBP implementation, is complex and hinges on coordination across levels of leadership [ 16 , 17 ].…”

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

“…Implementation frameworks posit the importance of organizational leaders and their use of specific leadership behaviors as potential mechanisms to improve EBP implementation in healthcare settings [17][18][19][20]. These frameworks converge on the importance of leaders at multiple levels-from executives who make decisions about whether to implement an EBP to first-level leaders who directly supervise clinicians [21][22][23]-as well as on the importance of aligning leadership across levels [24][25][26]. Furthermore, many frameworks suggest the unique importance of first-level leaders, also known as middle managers, who directly supervise frontline clinicians [21,27].…”

“…These implementation-focused leadership behaviors complement general transformational leadership; together, the two types of leadership contribute to a positive leader-follower relationship that is focused on the strategic imperative of effectively integrating EBP into care delivery [30]. Cross-sectional studies have shown that higher levels of implementation leadership among first-level leaders are linked to higher levels of EBP implementation climate [40,46,47] and superior clinician attitudes toward EBP [22]; however, we are unaware of any longitudinal studies that examine how implementation leadership changes over time or that link these changes to changes in EBP implementation climate.…”