van der Zijpp Teatske Johanna, Niessen Theo, Eldh Ann Catrine, Hawkes Claire, McMullan Christel, Mockford Carole, Wallin Lars, McCormack Brendan, Rycroft-Malone Jo, Seers Kate
Researcher and Lecturer, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands.
Associate Professor, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands.
Worldviews Evid Based Nurs. 2016 Feb;13(1):25-31. doi: 10.1111/wvn.12138. Epub 2016 Jan 20.
Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process.
To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people.
Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs.
This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings.
Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.
新出现的证据聚焦于领导力在成功将研究证据转化为实践中的重要作用。然而，对于管理型领导者和临床型领导者作为促进者（内部促进者[IFs]）在这一实施过程中的相互作用，我们所知甚少。
描述管理型领导者与内部促进者之间的相互作用，以及这种相互作用如何在为老年人提供长期护理的环境中，在当地背景下促进或阻碍尿失禁指南建议的实施过程。
对105名管理者和22名内部促进者进行半结构化访谈，这些访谈数据是为一项横跨四个欧洲国家的现实主义过程评估收集的，为本研究提供了信息。一项解释性数据分析揭示了管理型领导者与内部促进者之间的相互作用。
本研究确定了在管理型领导者与内部促进者的相互作用中，对实施过程可能产生阻碍或支持作用的三个重要主题：“实现承诺”；“协商条件”；以及“鼓励保持动力”。研究结果表明，内部促进者与管理型领导者之间持续的相互关系影响了实施的进展，可能会减缓或扰乱这一过程。“建造一座桥”跨越湍急河流的比喻成为理解研究结果的一种方式。
我们的研究结果揭示了一个被忽视的领域，即关键人员之间的关系对将证据转化为实践的影响。在规划指南实施和实践变革时，管理型和临床型领导角色的关系方面需要得到更多考虑。为了支持实施，被指定为内部促进者的工作人员以及组织各级的利益相关者，如管理者，都应参与到实现承诺、协商条件和保持动力中来。因此，所有相关人员之间的沟通至关重要。
