TY - JOUR
T1 - A stepped-wedge randomized trial investigating the effect of the Leadership and Organizational Change for Implementation (LOCI) intervention on implementation and transformational leadership, and implementation climate
AU - Skar, Ane Marthe Solheim
AU - Braathu, Nora
AU - Peters, Nadina
AU - Bækkelund, Harald
AU - Endsjø, Mathilde
AU - Babaii, Aida
AU - Borge, Randi Hovden
AU - Wentzel-Larsen, Tore
AU - Ehrhart, Mark G.
AU - Sklar, Marisa
AU - Brown, C. Hendricks
AU - Aarons, Gregory A.
AU - Egeland, Karina M.
N1 - Funding Information:
Thanks are due to the participating clinics who provided data for this study. We are grateful for the support from NKVTS.
Funding Information:
LOCI has been tested in one study [], and three ongoing randomized controlled trials [, ] are underway in the United States, funded by the US National Institutes of Health. Preliminary results have shown that LOCI is feasible and acceptable [] and is related to improved staff-rated leadership and implementation climate for EBP implementation [, , ]. Although there has been increased interest in approaches to leadership in implementation research and practice [–], there is a need for testing the effectiveness of strategies such as LOCI on implementation and transformational leadership and implementation climate in a variety of settings. Such knowledge can facilitate successful EBP implementation and sustainment. This is the first study to examine the effect of LOCI outside of the USA, potentially strengthening its generalizability. We aim to test the effect of LOCI on the factors specifically addressed in LOCI, namely implementation and transformational leadership and implementation climate compared to the non-LOCI condition. Based on theory and empirical evidence, we hypothesize that:
Funding Information:
The implementation project was funded by the Norwegian Ministry of Health and Care Services. The funders had no role in planning, designing, and analyzing the results.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate. Methods: A stepped wedge cluster randomized study design enrolling 47 first-level leaders from child- and adult-specialized mental health clinics within Norwegian health trusts across three cohorts. All therapists (n = 790) received training in screening of trauma exposure and posttraumatic stress, and a subgroup of therapists (n = 248) received training in evidence-based treatment methods for posttraumatic stress disorder (PTSD). First-level leaders and therapists completed surveys at baseline, 4, 8-, 12-, 16-, and 20-months assessing leadership and implementation climate. General linear mixed-effects models were used to investigate whether the LOCI strategy would lead to greater therapist-rated scores on implementation leadership, transformational leadership, and implementation climate. Results: After introducing the LOCI strategy, there was a significant increase in therapist-rated implementation and transformational leadership and implementation climate. The increase was sustained at all measurement time points compared to non-LOCI conditions, which demonstrated a steady decrease in scores before LOCI. Conclusions: The LOCI strategy can develop better transformational and implementation leadership skills and contribute to a more positive implementation climate, which may enhance successful EBP implementation. Thus, LOCI can help leaders create an organizational context conducive for effective EBP implementation. Trial registration: Retrospectively registered: ClinicalTrials NCT03719651, 25th of October 2018. The trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/.
AB - Background: This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate. Methods: A stepped wedge cluster randomized study design enrolling 47 first-level leaders from child- and adult-specialized mental health clinics within Norwegian health trusts across three cohorts. All therapists (n = 790) received training in screening of trauma exposure and posttraumatic stress, and a subgroup of therapists (n = 248) received training in evidence-based treatment methods for posttraumatic stress disorder (PTSD). First-level leaders and therapists completed surveys at baseline, 4, 8-, 12-, 16-, and 20-months assessing leadership and implementation climate. General linear mixed-effects models were used to investigate whether the LOCI strategy would lead to greater therapist-rated scores on implementation leadership, transformational leadership, and implementation climate. Results: After introducing the LOCI strategy, there was a significant increase in therapist-rated implementation and transformational leadership and implementation climate. The increase was sustained at all measurement time points compared to non-LOCI conditions, which demonstrated a steady decrease in scores before LOCI. Conclusions: The LOCI strategy can develop better transformational and implementation leadership skills and contribute to a more positive implementation climate, which may enhance successful EBP implementation. Thus, LOCI can help leaders create an organizational context conducive for effective EBP implementation. Trial registration: Retrospectively registered: ClinicalTrials NCT03719651, 25th of October 2018. The trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/.
KW - Evidence-based practice
KW - Implementation climate
KW - Implementation leadership
KW - Implementation strategies
KW - LOCI
KW - Mental health
KW - PTSD
KW - Transformational leadership
UR - http://www.scopus.com/inward/record.url?scp=85125813972&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85125813972&partnerID=8YFLogxK
U2 - 10.1186/s12913-022-07539-9
DO - 10.1186/s12913-022-07539-9
M3 - Article
C2 - 35246135
AN - SCOPUS:85125813972
VL - 22
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 298
ER -
