BMC Health Services Research (Mar 2022)

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

  • Ane-Marthe Solheim Skar,
  • Nora Braathu,
  • Nadina Peters,
  • Harald Bækkelund,
  • Mathilde Endsjø,
  • Aida Babaii,
  • Randi Hovden Borge,
  • Tore Wentzel-Larsen,
  • Mark G. Ehrhart,
  • Marisa Sklar,
  • C. Hendricks Brown,
  • Gregory A. Aarons,
  • Karina M. Egeland

DOI
https://doi.org/10.1186/s12913-022-07539-9
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 15

Abstract

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Abstract 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/ .

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