Abstract
BackgroundEvidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate.MethodsThis test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure.DiscussionLOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI.Trial registrationThis study is registered with Clinicaltrials.gov (NCT03042832), 2 February 2017, retrospectively registered.
Highlights
Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels
The approach seeks to cultivate and sustain both effective general and implementation leadership in conjunction with organizational strategies and supports that will remain after the implementation strategy has ended
Effective leadership in health and allied health services is associated with more positive staff attitudes toward adopting EBP, provider adoption of EBPs, improved staff work attitudes, and performance [51]
Summary
This study will test the effects of LOCI in facilitating MI implementation in SUDT service settings. H1b: Provider-rated implementation leadership will improve more in the LOCI vs control condition. Example hypotheses include: H4a: More positive workgroup level implementation climate will be associated with more positive provider-level attitudes toward EBP and implementation citizenship behaviors. H4b: More positive workgroup level psychological safety climate will be associated with more positive provider-level EBP attitudes and implementation citizenship behaviors. Inclusion criteria Participants for the proposed study will fall into three groups: (1) SUDT service providers (i.e., “service providers” n = 360), (2) SUDT workgroup supervisors (i.e., “workgroup supervisors” n = 60), and (3) SUDT agency executives and managers (i.e., “executives/managers” n = 60), total N = 480. LOCI intervention (1) 360° assessment Consenting workgroup supervisors, service providers who report to them, and executives/managers will participate in the quantitative web-based surveys. Tailoring organizational strategies to support the first-level leaders in developing an EBP climate. 2.1 Training
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