Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol

Karina M Egeland,C Hendricks Brown,Aida Babaii,Marisa Sklar,Gry Kristina Husebø,Gregory A Aarons,Harald Bækkelund,Ane-Marthe Solheim Skar,Randi Hovden Borge,Mark G Ehrhart,Lene Beate Granly,Erlend Høen Laukvik,Mathilde Endsjø

doi:10.1186/s13012-019-0873-7

Abstract

BackgroundAlignment across levels of leadership within an organization is needed for successful implementation of evidence-based practice. The leadership and organizational change for implementation (LOCI) intervention is a multi-faceted multilevel implementation strategy focusing on enhancing first-level general and implementation leadership while also engaging with organization upper management to develop an organizational climate for implementation. The aim of the project is to evaluate the effectiveness of LOCI in supporting the implementation of evidence-based treatment for PTSD in child- and adult-specialized mental health clinics in health trusts in Norway.MethodsThe study design is a stepped-wedge cluster randomized trial with enrollment of clinics in three cohorts. Executives, clinic leaders, and therapists will be asked to complete surveys assessing leadership and implementation climate. Surveys will be completed at baseline, 4, 8, 12, 16, and 20 months. Results from surveys will be shared with executives and clinic leaders to inform the subsequent creation of tailored leadership and climate development plans for enhanced implementation. Patients will complete surveys measuring traumatic events and post-traumatic stress symptoms during the therapy process. Therapy sessions will be audio or video recorded and scored for fidelity as part of training.DiscussionThis study aims to provide knowledge on how to improve leadership and organizational climate to enhance effective implementation of evidence-based treatments in mental health services.Trial registrationThe study has been registrated in ClinicalTrials with ID NCT03719651.

Highlights

Health service managers face several leadership challenges in evidence-based practice (EBP) implementation, as they need to ensure efficient use of resources and to prioritize the quality of services to be provided
Research has pointed to therapists’ concerns about using exposure-based treatment as a barrier to implementation, as they believe it can exacerbate both post-traumatic stress disorders (PTSD) and comorbid symptoms [57], and that findings from clinical trials may not be representative for their patient population [58]
In order to increase the probability that patients will receive the most effective care for their symptoms, the leaders have to obtain effective strategies to promote the adoption of the EBP

Summary

Introduction

Health service managers face several leadership challenges in evidence-based practice (EBP) implementation, as they need to ensure efficient use of resources and to prioritize the quality of services to be provided. Efforts that do not consider both contextual and individual factors likely to facilitate or hinder EBP implementation may result in poor or failed implementation, substandard service delivery, compromised patient outcomes, and decreased public health impact [5]. This project will test strategies and develop knowledge on how health care organizations and managers can lead the implementation of EBPs for post-traumatic stress disorders (PTSD) in child- and adult-specialized mental health services.

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