Department of Medicine, University of Toronto, Toronto, Canada.
Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michaels Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
BMC Health Serv Res. 2020 Jun 5;20(1):513. doi: 10.1186/s12913-020-05386-0.
Little is known about how to build leadership capacity to support implementation of evidence-based practices within health systems. We observed substantial variability across sites in uptake and sustainability of a peer-led educational outreach intervention for lay health workers (LHWs) providing tuberculosis care in Malawi. Feedback from peer-trainers (PTs) suggested that leadership may have contributed to the variation. We sought to assess the impact of PT leadership style on implementation, and to identify leadership traits of more successful PTs, to inform future implementation planning and to identify targets for leadership capacity building.
Qualitative study employing interviews with PTs and LHWs at high and low implementation sites, and review of study team and quarterly PT meeting notes. High implementation sites achieved high uptake, sustainability and fidelity of implementation including: close adherence to training content and process, high levels of coverage (training most or all eligible LHWs at their site), and outcomes were achieved with high levels of self reported competence with the intervention among both PTs and LHWs. Low implementation sites achieved limited coverage (<= 50% of LHWs trained), and intervention fidelity.
Eight PTs and 10 LHWs from eight high and 10 low implementation sites participated in interviews. Leadership traits of more successful PTs included: flexibility in their approach to training, role modeling and provision of supportive supervision to support learning; addressing challenges proactively and as they occurred; collaborative planning; knowledgeable; and availability to support implementation. Traits unique to less successful PTs included: a poor attitude toward their role as PT and a passive-avoidant approach to challenges.
This study identified leadership traits more common among unit level leaders at sites with higher uptake, sustainability, and fidelity of implementation. These findings provide a starting point for development and evaluation of a leadership capacity building intervention for unit level leaders to support implementation.
对于如何在卫生系统中建立领导力以支持实施基于证据的实践，我们知之甚少。我们观察到，在马拉维，一项针对提供结核病护理的基层卫生工作者（LHW）的同行主导教育外展干预措施的采用和可持续性方面，各个地点之间存在很大差异。同行培训师（PT）的反馈表明，领导力可能是造成这种差异的原因之一。我们试图评估 PT 领导风格对实施的影响，并确定更成功的 PT 的领导特质，以为未来的实施计划提供信息，并确定领导力能力建设的目标。
采用访谈的方法，对高、低实施地点的 PT 和 LHW 进行定性研究，并对研究团队和季度 PT 会议记录进行审查。高实施地点实现了较高的采用率、可持续性和实施保真度，包括：紧密遵循培训内容和流程、高水平的覆盖率（在其所在地点培训大多数或所有符合条件的 LHW），并且 PT 和 LHW 都对干预措施的自我报告能力有较高的评价。低实施地点的覆盖率有限（培训的 LHW 人数<=50%），并且干预措施的保真度也较低。
来自 8 个高实施地点和 10 个低实施地点的 8 名 PT 和 10 名 LHW 参加了访谈。更成功的 PT 的领导特质包括：培训方法灵活、以身作则并提供支持性监督以支持学习；主动并及时解决挑战；协作性规划；知识渊博；并随时支持实施。不太成功的 PT 所具有的独特特质包括：对其作为 PT 的角色的不良态度以及对挑战的被动回避态度。
这项研究确定了在采用率、可持续性和实施保真度较高的地点，更常见于基层领导的领导特质。这些发现为开发和评估针对基层领导的领导力能力建设干预措施以支持实施提供了起点。
