Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation.

There has been a growing impetus to bridge the gap between basic science discovery, development of evidence-based practices (EBPs), and the availability and delivery of EBPs in order to improve the public health impact of such practices. To capitalize on factors that support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups. Leaders play a key role in determining the nature of system and organizational contexts. This article addresses the role of leadership and actions that leaders can take at and across levels in developing a strategic climate for EBP implementation within the outer (i.e., system) and inner (i.e., organization, work group) contexts of health care. Within the framework of Edgar Schein's "climate embedding mechanisms," we describe strategies that leaders at the system, organization, and work group levels can consider and apply to develop strategic climates that support the implementation and sustainment of EBP in health care and allied health care settings.

[1]  Karlheinz Sonntag,et al.  Shedding light on followers' innovation implementation behavior , 2010 .

[2]  D. Russell,et al.  The effect of social support and the work environment upon burnout among nurses. , 1986, Journal of human stress.

[3]  S. Shortell,et al.  Improving the quality of health care in the United Kingdom and the United States: a framework for change. , 2001, The Milbank quarterly.

[4]  G. Aarons,et al.  Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation. , 2012, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  E. Schein.  Organizational Culture and Leadership , 1991 .

[6]  R. Hughes.  Patient Safety and Quality: An Evidence-Based Handbook for Nurses , 2008 .

[7]  Marshall Schminke,et al.  Assembling Fragments Into a Lens: A Review, Critique, and Proposed Research Agenda for the Organizational Work Climate Literature , 2009 .

[8]  Timothy T. Baldwin,et al.  Do leaders reap what they sow? Leader and employee outcomes of leader organizational cynicism about change , 2009 .

[9]  David A Chambers,et al.  Bridging research and practice: models for dissemination and implementation research. , 2012, American journal of preventive medicine.

[10]  Mike R. Murphy,et al.  Chapter 28 . The Impact of Facility Design on Patient Safety , 2008 .

[11]  H. Gotham.  Diffusion of Mental Health and Substance Abuse Treatments: Development, Dissemination, and Implementation , 2006 .

[12]  G. Aarons.  Mental Health Provider Attitudes Toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS) , 2004, Mental health services research.

[13]  V. Ganju.  Implementation of evidence-based practices in state mental health systems: implications for research and effectiveness studies. , 2003, Schizophrenia bulletin.

[14]  Scott B. MacKenzie,et al.  Transformational Leader Behaviors and Substitutes for Leadership as Determinants of Employee Satisfaction, Commitment, Trust, and Organizational Citizenship Behaviors , 1996 .

[15]  M. Hogan,et al.  The President's New Freedom Commission: recommendations to transform mental health care in America. , 2003, Psychiatric services.

[16]  K. Klein,et al.  The Challenge of Innovation Implementation , 1996 .

[17]  Tor Guimaraes,et al.  Hospital organization culture, capacity to innovate and success in technology adoption. , 2006, Journal of health organization and management.

[18]  S. Henggeler,et al.  Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. , 2008, Journal of consulting and clinical psychology.

[19]  G. Robert,et al.  Diffusion of innovations in service organizations: systematic review and recommendations. , 2004, The Milbank quarterly.

[20]  D. Jung,et al.  The role of transformational leadership in enhancing organizational innovation: Hypotheses and some preliminary findings , 2003 .

[21]  Gregory A Aarons,et al.  The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform. , 2011, Psychological services.

[22]  L. Green,et al.  Diffusion Theory and Knowledge Dissemination, Utilization, and Integration in Public Health , 2009, Annual review of public health.

[23]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[24]  B. Bass,et al.  Superiors' evaluations and subordinates' perceptions of transformational and transactional leadership. , 1988 .

[25]  Chia-Huei Emily Ko,et al.  Organizational and psychological climate: A review of theory and research , 2008 .

[26]  Shaul Oreg,et al.  LEADERSHIP AND EMPLOYEES’ REACTIONS TO CHANGE: THE ROLE OF LEADERS’ PERSONAL ATTRIBUTES AND TRANSFORMATIONAL LEADERSHIP STYLE , 2011 .

[27]  Shin-Ping Tu,et al.  Systems Antecedents for Dissemination and Implementation , 2012, Health education & behavior : the official publication of the Society for Public Health Education.

[28]  E. Ferlie,et al.  Process Transformation: Limitations to Radical Organizational Change within Public Service Organizations , 2004 .

[29]  Fred O. Walumbwa,et al.  Transformational leadership, organizational commitment, and job satisfaction: A comparative study of Kenyan and U.S. financial firms , 2005 .

[30]  I. MacMillan,et al.  Strategy implementation versus middle management self-interest , 1986 .

[31]  Alicia C. Bunger,et al.  Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[32]  David A. Hofmann,et al.  Organizational Culture and Climate , 2012 .

[33]  Albert A. Cannella,et al.  Contrasting Perspectives on Strategic Leaders: Toward a More Realistic View of Top Managers , 1997 .

[34]  Justin Waring,et al.  Managing Expert Knowledge: Organizational Challenges and Managerial Futures for the UK Medical Profession , 2009 .

[35]  Benjamin Schneider,et al.  Organizational Climate and Culture: An Introduction to Theory, Research, and Practice , 2006 .

[36]  E. Schein.  The Role of the Founder in Creating Organizational Culture , 1983 .

[37]  D. Mcgregor.  The Human Side of Enterprise , 1960 .

[38]  D. Zohar.  Safety climate in industrial organizations: theoretical and applied implications. , 1980, The Journal of applied psychology.

[39]  J. G. Hunt.  Leadership: A New Synthesis , 1991 .

[40]  S. Asch,et al.  Enhancing Organizational Change and Improvement Prospects: Lessons from an HIV Testing Intervention for Veterans , 2008 .

[41]  Benjamin Schneider,et al.  Understanding organization-customer links in service settings. , 2005 .

[42]  P. Corrigan,et al.  Transformational Leadership and the Mental Health Team , 2002, Administration and Policy in Mental Health and Mental Health Services Research.

[43]  Anne W. Todd,et al.  A randomized wait-list controlled analysis of the implementation integrity of team-initiated problem solving processes. , 2012, Journal of school psychology.

[44]  J. Sallis,et al.  Role of Built Environments in Physical Activity, Obesity, and Cardiovascular Disease , 2012, Circulation.

[45]  C. Shalley,et al.  A Little Creativity Goes a Long Way: An Examination of Teams’ Engagement in Creative Processes , 2004 .

[46]  M. Taylor,et al.  Building Employee Commitment to Change Across Organizational Levels: The Influence of Hierarchical Distance and Direct Managers' Transformational Leadership , 2012 .

[47]  Amy Buhl Conn,et al.  Implementing computerized technology: an organizational analysis. , 2001, The Journal of applied psychology.

[48]  Ronald Lippitt,et al.  Patterns of Aggressive Behavior in Experimentally Created “Social Climates” , 1939 .

[49]  Ralf Stegmaier,et al.  Affective Commitment to Change and Innovation Implementation Behavior: The Role of Charismatic Leadership and Employees’ Trust in Top Management , 2009 .

[50]  G. Aarons.  Transformational and transactional leadership: association with attitudes toward evidence-based practice. , 2006, Psychiatric services.

[51]  Gordon H Guyatt,et al.  Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review , 2013, BMJ Open.

[52]  Benjamin Schneider,et al.  Organizational Climate Research: Achievements and the Road Ahead , 2011 .

[53]  Berna J. Skrypnek,et al.  The promise of spirit at work: increasing job satisfaction and organizational commitment and reducing turnover and absenteeism in long-term care. , 2008, Journal of gerontological nursing.

[54]  R. Drake,et al.  Evidence-based practices: setting the context and responding to concerns. , 2003, The Psychiatric clinics of North America.

[55]  Charles A. O'Reilly,et al.  How leadership matters: The effects of leaders' alignment on strategy implementation , 2010 .

[56]  M. Titler.  The Evidence for Evidence-Based Practice Implementation , 2008 .

[57]  Jane M. Howell,et al.  Transformational leadership, transactional leadership, locus of control, and support for innovation: key predictors of consolidated-business-unit performance , 1993 .

[58]  D. Zohar.  Modifying supervisory practices to improve subunit safety: a leadership-based intervention model. , 2002, The Journal of applied psychology.

[59]  G. Aarons,et al.  Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[60]  Carl R. Rogers,et al.  Active Listening , 2015 .

[61]  J. Lowery,et al.  Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science , 2009, Implementation science : IS.

[62]  E. Guerrero,et al.  Organizational structure, leadership and readiness for change and the implementation of organizational cultural competence in addiction health services. , 2013, Evaluation and program planning.

[63]  James A. Phills.  Integrating mission and strategy for nonprofit organizations , 2005 .

[64]  R. Brownson,et al.  Barriers to Evidence-Based Decision Making in Public Health: A National Survey of Chronic Disease Practitioners , 2010, Public health reports.

[65]  D. Zohar.  A group-level model of safety climate: testing the effect of group climate on microaccidents in manufacturing jobs. , 2000, The Journal of applied psychology.

[66]  B. Schneider,et al.  Organizational climate and culture. , 2009, Annual review of psychology.

[67]  Eugenia G. Kelman,et al.  Data feedback and group problem‐solving: An approach to organizational development in schools , 1976 .

[68]  Backer Te,et al.  Synthesis of behavioral science learnings about technology transfer. , 1995 .

[69]  Sonja K Schoenwald,et al.  The ARC Organizational and Community Intervention Strategy for Implementing Evidence-Based Children's Mental Health Treatments , 2005, Mental health services research.

[70]  Brad J. Nakamura,et al.  Engineering Youth Service System Infrastructure: Hawaii's Continued Efforts at Large-Scale Implementation Through Knowledge Management Strategies , 2014, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[71]  S. Floyd,et al.  The strategy process, middle management involvement, and organizational performance , 1990 .

[72]  A. Best,et al.  It's a matter of values: partnership for innovative change. , 2011, HealthcarePapers.

[73]  Susan S. White,et al.  Linking service climate and customer perceptions of service quality: test of a causal model. , 1998, The Journal of applied psychology.

[74]  K. Emmons,et al.  How can we increase translation of research into practice? Types of evidence needed. , 2007, Annual review of public health.

[75]  David A. Waldman,et al.  Leadership and outcomes of performance appraisal processes , 1987 .

[76]  P. Corso,et al.  The effectiveness of interventions to increase physical activity. A systematic review. , 2002, American journal of preventive medicine.

[77]  Jay A. Conger,et al.  Charismatic Leadership: The Elusive Factor in Organizational Effectiveness , 1988 .

[78]  B. Bass,et al.  Predicting unit performance by assessing transformational and transactional leadership. , 2003, The Journal of applied psychology.

[79]  K. Stamatakis,et al.  Dissemination and Implementation Research in Community and Public Health Settings , 2012 .

[80]  R. Brownson,et al.  Evidence-based Decision Making to Improve Public Health Practice , 2013 .

[81]  Samia Chreim,et al.  Radical change in healthcare organization: mapping transition between templates, enabling factors, and implementation processes. , 2012, Journal of health organization and management.

[82]  R. Glasgow,et al.  Preventive care practices for diabetes management in two primary care samples. , 2000, American journal of preventive medicine.

[83]  Chris Argyris,et al.  Some Problems in Conceptualizing Organizational Climate: A Case Study of a Bank , 1958 .

[84]  R B Haynes,et al.  Can computerized clinical decision support systems improve diabetes management? A systematic review and meta‐analysis , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[85]  L. Palinkas,et al.  Dynamic adaptation process to implement an evidence-based child maltreatment intervention , 2012, Implementation Science.

[86]  R. Stagner.  Corporate decision making: An empirical study. , 1969 .

[87]  W. Burke.  Organization Change: Theory and Practice , 2002 .

[88]  Ulf H. Olsson,et al.  Modeling attitudes and perceptions as predictors for changing safety margins during organizational change , 2011 .

[89]  K. Kelleher,et al.  Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[90]  Julio J. Rotemberg,et al.  Leadership Style and Incentives , 2015 .

[91]  B. Bass.  LEADERSHIP AND PERFORMANCE BEYOND EXPECTATIONS , 1985 .

[92]  L. Pezzin,et al.  Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes. , 2005, Health services research.

[93]  Rick D. Hackett,et al.  Further assessments of Bass's (1985) conceptualization of transactional and transformational leadership. , 1995 .

[94]  G. Aarons,et al.  The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership , 2014, Implementation Science.

[95]  Michael VonKorff,et al.  Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care , 2000, BMJ : British Medical Journal.

[96]  Leonard Bickman,et al.  The Technology of Measurement Feedback Systems. , 2012, Couple & family psychology.

[97]  M. Laurant,et al.  Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study , 2012, Implementation Science.

[98]  A. Sarkin,et al.  The psychometric properties of the Illness Management and Recovery scale in a large American public mental health system , 2012, Psychiatry Research.

[99]  Traci R. Rieckmann,et al.  Implementation of Evidence-Based Practices for Treatment of Alcohol and Drug Disorders: The Role of the State Authority , 2009, The Journal of Behavioral Health Services & Research.

[100]  L. Pezzin,et al.  Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients? , 2005, Journal of pain and symptom management.

[101]  Graham A Colditz,et al.  Implementation science and its application to population health. , 2013, Annual review of public health.

[102]  Benjamin Schneider,et al.  Perspectives on organizational climate and culture. , 2011 .

[103]  Amy Buhl Conn,et al.  Is everyone in agreement? An exploration of within-group agreement in employee perceptions of the work environment. , 2001, The Journal of applied psychology.

[104]  K. Glanz,et al.  The role of behavioral science theory in development and implementation of public health interventions. , 2010, Annual review of public health.

[105]  R. Newhouse.  Johns Hopkins Nursing - Evidence-Based Practice Model And Guidelines , 2007 .

[106]  Réjean Landry,et al.  The Extent and Organizational Determinants of Research Utilization in Canadian Health Services Organizations , 2007 .

[107]  Andreas Priestland,et al.  Developing first-level leaders. , 2005, Harvard business review.

[108]  Chris Argyris,et al.  Knowledge for Action: A Guide to Overcoming Barriers to Organizational Change , 1993 .

[109]  Phyllis C. Panzano,et al.  The De-adoption of Innovative Mental Health Practices (IMHP): Why Organizations Choose not to Sustain an IMHP , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[110]  Dov Zohar,et al.  Improving construction site safety through leader-based verbal safety communication. , 2010, Journal of safety research.

[111]  L. James,et al.  Integrating Work Environment Perceptions: Explorations into the Measurement of Meaning , 1989 .

[112]  David A. Chambers,et al.  Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[113]  E. McGlynn,et al.  The quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[114]  E. Balas,et al.  Managing Clinical Knowledge for Health Care Improvement , 2000, Yearbook of Medical Informatics.