The Impact of Inner and Outer Context on Line Managers’ Implementation Leadership

Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms

“…Together, barriers that exist at different levels of the implementation setting may interact and in turn impact the implementation effort's outcome and success (29,31). For example, results from Mosson et al (32) found that managers in smaller organizations or those in rural areas had difficulty with implementation due to barriers that impacted them at the individual level, such as lack of training or preparedness. This occurred, in part, due to the organization's geographical location, causing training opportunities to be infrequent (32).…”

“…It is important to discuss the importance of contextual factors, specifically the inner (i.e., organization's size, location, culture, climate) and outer (i.e., political, economic, social factors) setting, as clinical champions are impacted greatly by the environments in which they are engaging and trying to transform (29,32). As implementation efforts occur in complex systems that have various levels of influence ranging from the system-to patientlevel, it is important to understand how these factors interact with implementation strategies and impact implementation (73).…”

“…As implementation efforts occur in complex systems that have various levels of influence ranging from the system-to patientlevel, it is important to understand how these factors interact with implementation strategies and impact implementation (73). Barriers at both the inner and outer setting levels can impede leadership's impact on achieving successful implementation efforts (32,73). Understanding how organizational context interacts with implementation strategies is needed to further the field's understanding of how implementation strategies operate and yield desired outcomes.…”

“…Common outer setting barriers include organization and policy makers interest and willingness to support the implementation initiative and other policy-related barriers (e.g., financial disincentives) (16,32). Implementation efforts occurring within organizations who supported the implementation initiative via funding or trainings (i.e., providing trainings for how to utilize the EBP) typically had more impactful implementation outcomes and success (32). Supportive environments allow for implementation leaders to provide staff with ample high-quality training opportunities and the financial support needed to invest in the implementation process (32).…”

“…Implementation efforts occurring within organizations who supported the implementation initiative via funding or trainings (i.e., providing trainings for how to utilize the EBP) typically had more impactful implementation outcomes and success (32). Supportive environments allow for implementation leaders to provide staff with ample high-quality training opportunities and the financial support needed to invest in the implementation process (32). Results from (16) observed that clinical champions working in an environment with substantial outer context barriers, such as financial disincentives, resulted in unsuccessful implementation and even de-implementation due to the inability to overcome such barriers.…”