Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services

Abstract

BackgroundDespite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices.MethodsWe relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs.ResultsFindings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts.ConclusionsThese findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.

Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory-based leadership interventions

“… 11 – 13 Yet, most are unprepared for their roles in implementing change and are often unaware of effective approaches and strategies for success. 14 Despite growing research in the field, the mechanisms by which leadership influences implementation are not well understood. To stimulate and support additional empirical work in this area, it is essential to identify and understand the aspects of leadership that are critical for implementation, so that capacity-building interventions can be developed and tested to facilitate successful implementation of EBP change.…”

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“…Thus, the SM might increase the probability that sustainability can be achieved. There is increasing evidence for this in terms of leadership in implementation [ 13 ]. Leaders’ attitudes, priorities, and behavior [ 14 ] are increasingly being seen as major contributors to outcomes for employees and organizations [ 13 , 15 ] suggested that leadership behaviors represent orientations such as being able to guide the implementation process properly, being proactive in responding to implementation needs, being supportive to care staff during the introduction of new practices, and persevering in addressing obstacles that are expected to stall implementation efforts.…”

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“…The engagement of team members in improvement actions was provided by the activity of clinical managers (senior anesthetists or heads of department who have professional legitimacy among anesthetists) and was often unnoticed by staff. Studies in the field of implementation sciences often highlight the importance of local leadership involvement in the implementation of quality improvements [ 29 , 30 ]. Our pragmatic perspective allowed us to specify the nature of this local leadership involvement.…”