Gifford Wendy, Lewis Krystina B, Eldh Ann Catrine, Fiset Val, Abdul-Fatah Tara, Aberg Anna Cristina, Thavorn Kednapa, Graham Ian D, Wallin Lars
1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.
2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.
Pilot Feasibility Stud. 2019 Aug 19;5:103. doi: 10.1186/s40814-019-0485-7. eCollection 2019.
Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants' engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.
We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants ( = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.
Delivery of the leadership intervention was feasible. All participants ( = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0-4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.
The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.
领导力对于支持和促进医疗保健中循证实践的实施至关重要。然而，对于如何为此目的培养领导能力却知之甚少。本研究的目的是探讨：（1）提供领导力干预措施以促进实施的可行性；（2）领导力干预措施的有用性；（3）参与者在加拿大长期护理机构中参与领导以实施循证跌倒预防实践的情况。
我们在加拿大一家长期护理机构的两个单元进行了一项前后对照的混合方法可行性研究。领导力干预基于渥太华实施领导力模型（O-MILe），包括为期3个月的两个工作坊和两次个性化辅导课程，以培养实施循证跌倒预防实践的领导能力。参与者（n = 10）包括正式领导者（如管理人员）和非正式领导者（如护士和护理助理负责人）。结果指标包括可行性参数（如参加工作坊和辅导课程的合格候选人数量）和领导力干预措施的有用性（如评分、建议的修改）。我们以实施领导力量表（ILS）为指导进行了半结构化访谈，该量表是一种经过验证的12项量表，分为四个子类别（积极主动、支持、知识渊博和坚持不懈），以探讨参与者用于实施跌倒预防实践的领导行为。我们在焦点小组会议上重复使用ILS，以了解干预团队使用的集体领导行为。还探讨了领导实施的障碍和促进因素。
提供领导力干预措施是可行的。所有参与者（n = 10）都参加了工作坊，8人参加了至少一次辅导课程。分别有71%和86%的参与者将工作坊和辅导评为有用（在0至4的李克特量表上≥3，其中4表示非常有用）。参与者将支持性和坚持不懈的领导力的O-MILe子类别评为个人领导的最高类别，而支持性和知识渊博的领导力被评为团队领导的最高类别。
领导力干预措施的实施是可行的，参与者认为其有用，并促进了对实施领导活动的参与。研究结果突出了培养实施领导力的复杂性以及优化影响所需的修改。现在需要进行未来试验，以测试领导力干预措施对培养实施循证实践的领导力的有效性。
