Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis
Abstract 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, persevera...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-020-0970-7 |
| _version_ | 1824026324680835072 |
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| author | Nathaniel J. Williams Courtney Benjamin Wolk Emily M. Becker-Haimes Rinad S. Beidas |
| author_facet | Nathaniel J. Williams Courtney Benjamin Wolk Emily M. Becker-Haimes Rinad S. Beidas |
| author_sort | Nathaniel J. Williams |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-19T11:13:07Z |
| format | Article |
| id | doaj.art-3ec96eab3b344963afad14c4a9887bf6 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-19T11:13:07Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-3ec96eab3b344963afad14c4a9887bf62022-12-21T20:24:08ZengBMCImplementation Science1748-59082020-02-0115111510.1186/s13012-020-0970-7Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysisNathaniel J. Williams0Courtney Benjamin Wolk1Emily M. Becker-Haimes2Rinad S. Beidas3School of Social Work, Boise State UniversityDepartment of Psychiatry, Perelman School of Medicine, University of PennsylvaniaDepartment of Psychiatry, Perelman School of Medicine, University of PennsylvaniaDepartment of Psychiatry, Perelman School of Medicine, University of PennsylvaniaAbstract 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.https://doi.org/10.1186/s13012-020-0970-7Implementation leadershipImplementation climateBehavioral healthEvidence-based practiceMediationMechanism |
| spellingShingle | Nathaniel J. Williams Courtney Benjamin Wolk Emily M. Becker-Haimes Rinad S. Beidas Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis Implementation Science Implementation leadership Implementation climate Behavioral health Evidence-based practice Mediation Mechanism |
| title | Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis |
| title_full | Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis |
| title_fullStr | Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis |
| title_full_unstemmed | Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis |
| title_short | Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis |
| title_sort | testing a theory of strategic implementation leadership implementation climate and clinicians use of evidence based practice a 5 year panel analysis |
| topic | Implementation leadership Implementation climate Behavioral health Evidence-based practice Mediation Mechanism |
| url | https://doi.org/10.1186/s13012-020-0970-7 |
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