Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA, 98195, USA.
Implement Sci. 2021 Jul 6;16(1):69. doi: 10.1186/s13012-021-01104-4.
First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders' access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes.
A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks.
Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership's positive relationship with providers' EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers' role in implementation.
Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation.
This review was not registered.
由于一级领导者能够接触并与服务提供者建立关系，因此他们在支持行为健康循证实践（EBP）的实施方面处于独特的地位。一级领导者是直接监督和管理不管理他人的一线员工的个人。然而，在现有的领导力对 EBP 实施影响的综述中，一级领导力的代表性不足。本综述描述了一级领导力与内在环境和实施结果之间的关系。
进行了范围综述，以综合关于一级领导力与内在环境和实施结果之间关系的文献。在 PubMed、Eric、PsycINFO、CINAHL、Scopus 和 Web of Science 中进行了文献检索。符合条件的研究必须检查一级领导力，在提供行为健康服务的环境中进行，并检查一级领导力与实施或内在环境结果之间的关系。为了描述研究特征、领导者-结果关系以及领导力框架的重叠，进行了数据提取和综合。
有 21 项记录符合我们的纳入标准。研究主要依赖于观察性设计，且通常是横断面研究。研究更经常检查一般领导力，而不是专注于 EBP 实施的领导力（即战略实施领导力）。我们的研究结果表明，几种形式的一级领导力与广泛的实施决定因素不一致相关，而很少检查具体的实施结果。所研究的实施决定因素广泛，重复次数有限，以及不一致的发现导致任何特定领导力-结果关系的证据很少。证据最多的是一般领导力与提供者的 EBP 态度之间的积极关系，尤其是在变革型领导的形式上。其次是战略实施领导力促进一般实施的证据。我们的综合研究揭示了实施领导力理论和中层管理者在实施中的角色理论中描述的战略实施领导力行为的中等概念重叠。
我们的研究结果表明，一级领导力可能在塑造实施决定因素和结果方面发挥重要作用，但一致的实证支持是稀疏的，并且受到方法学问题的影响。为了推进这一领域，我们需要采用更强的方法学严谨性的研究，解决领导力框架的概念重叠问题，检查更广泛的实施结果，并研究领导对实施产生影响的条件。
