Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

Abstract

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. • Pilot studies preceding larger implementation studies are useful to ensure both intervention and data collection feasibility. Implications for the publicTo this day, changes in healthcare are a major challenge; many of today's errors and adverse events could be prevented by using evidence-based practice (EBP). However, implementing EBP is easier said than done, and a complete picture as to what facilitates this process is yet to come. One aspect considered vital is the behavior of managers to facilitate guideline implementation. In this study, we piloted a leadership intervention based on a particular theoretical model to support managers in developing implementation plans. We found that the managers appreciated the model, and found it relevant to their practice. However, few implementation plans reflected their own role in facilitating the implementation of stroke rehabilitation guidelines. Further studies should provide supplementary support to managers, in order to facilitate their guideline implementation.

Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists

“…Time constraints can affect the possibility of applying research findings in clinical practice (Aljadi et al, 2013;Janssen et al, 2016). Leadership plays an important role in enabling research use in clinical practice and implementing guidelines (Dannapfel et al, 2013;Tistad et al, 2016).…”

Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries

“…Some literature suggests that middle managers -those who supervise front-line employees, but are themselves supervised by senior managers -have an important, but as yet overlooked, role in implementing EBP (20). However, empirical studies testing interventions to build management capacity for implementing EBP have produced mixed results (21,22), linked to a view that the nurse manager's role in EBP is under-articulated, largely passive and limited by competing demands (23) or that nurse managers lack the knowledge and skills needed to effectively support EBP (24,25).…”

Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper

“…While a clinical intervention can sometimes be supplemented with an implementation strategy (implicitly or explicitly), our cases illustrate the twofold interest for the clinical intervention and the implementation intervention [37, 38]. In both studies the primary outcomes were clinical: the impact of the falls prevention program on rates and severities of falls in older people, and the impact of rehabilitation on ADL function.…”

“…For example, TIDieR requires outlining the provider and types of location(s) of the clinical intervention; in the falls prevention example, providers could be nurses, rehabilitation professionals and unregulated staff, and the ‘locations’ residential care homes. By comparison, CReDECI would draw out the core components (for example, stroke rehabilitation), along with the theory underpinning the implementation intervention (in this case the Promoting Action on Research Implementation in Health Services framework and the Ottawa Model of Implementation Leadership) [38]. Further, in the stroke rehabilitation study, the national stroke guidelines were assessed for feasibility and usefulness, and data on context was collected, including for example leadership, culture, and organizational structure, in alignment with the criteria of CReDECI related to facilitators, barriers, and external factors that influence implementation.…”