Individual-level associations between implementation leadership, climate, and anticipated outcomes: a time-lagged mediation analysis.

BACKGROUND: Leaders can improve implementation outcomes by developing an organizational climate conducive to the implementation of evidence-based practices (EBP). This study tested the lagged associations between individual-level perceptions of implementation leadership, implementation climate, and three anticipated implementation outcomes, that is EBP acceptability, appropriateness, and feasibility. METHODS: Screening tools and treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample of 494 child and adult mental health care professionals (M = 43 years, 78% female) completed surveys addressing perceptions of first-level leaders' (n = 47) implementation leadership and their clinics' implementation climate. Single-level structural equation models estimating both direct, indirect, and total effects were used to investigate whether perceived implementation climate mediated the association between perceived implementation leadership and perceived acceptability, appropriateness, and feasibility of screening tools and treatment methods. RESULTS: Regarding the treatment methods, implementation leadership was associated with therapists' perceptions of acceptability, appropriateness, and feasibility. Implementation climate also mediated between implementation leadership and the outcomes. Regarding the screening tools, implementation leadership was not associated with the outcomes. However, implementation climate mediated between implementation leadership and therapists' perceptions of acceptability and feasibility, but not appropriateness. Analyses with the implementation climate subscales showed stronger associations for therapists' perceptions of the treatment methods than of screening tools. CONCLUSIONS: Leaders may promote positive implementation outcomes, both directly and through implementation climate. With regard to the effect sizes and explained variance, results indicated that both implementation leadership and implementation climate were more strongly associated with the therapists' perceptions of the treatment methods, implemented by one group of therapists, than the screening tools, implemented by all therapists. This may imply that implementation leadership and climate may have stronger effects for smaller implementation teams within a larger system than for system-wide implementations or when the clinical interventions being implemented are more complex rather than simple ones. TRIAL REGISTRATION: ClinicalTrials NCT03719651, 25 October 2018.

Office design, telework from home, and self-certified sickness absence: A cross-sectional study of main and moderating effects in a nationally representative sample.

OBJECTIVES: This study aimed to investigate (i) the main effects of office design and access to telework from home (TWFH) on self-certified sickness absence and (ii) the moderating effects of access to TWFH on the relationship between office design and self-certified sickness absence. METHODS: The study used cross-sectional survey data from a nationally representative sample from Norway (N=4329). Research objectives were investigated with negative binomial hurdle models, adjusting for age, gender, education level, leadership responsibility, and time spent on office work. Moderating effects of TWFH were evaluated with pairwise comparisons and plots of estimated marginal means. RESULTS: In adjusted models, employees in conventional open-plan offices [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.13-1.54] had significantly higher odds of sickness absence than employees in private offices. Employees with access to TWFH (OR 0.86, 95% CI 0.74-0.99) had significantly lower odds of sickness absence than employees with no access. Among employees with access to TWFH, those in conventional open-plan offices had significantly higher predicted probability of self-certified sickness absence than those in private offices (z=4.41, P<0.0001). There were no significant differences between office designs among employees who did not have access to TWFH. There were no significant main or moderating effects on the number of sickness absence episodes in adjusted models. CONCLUSIONS: The current study identifies conventional open-plan offices as a potential risk factor for sickness absence. While access to TWFH may be a protective factor overall, it amplified - rather than attenuated - differences in sickness absence between employees in private offices and conventional open-plan offices.

"Change Doesn't Happen by Itself": A Thematic Analysis of First-Level Leaders' Experiences Participating in the Leadership and Organizational Change for Implementation (LOCI) Strategy.

The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by participants is important for their utilization and effectiveness in supporting EBP implementation. The current study is the first in-depth qualitative study exploring first-level leaders' experiences of participating in the LOCI strategy. Data were collected as part of a trial where Norwegian child and adult mental health outpatient clinics implemented EBPs for posttraumatic stress disorder (PTSD). Eleven first-level leaders from adult and child clinics participated in semi-structured interviews after completing the LOCI strategy. Data were analyzed through reflexive thematic analysis. The analysis generated four themes related to leaders' experiences of participating in the LOCI strategy: (1) structuring the EBP implementation, (2) taking responsibility for the EBP implementation, (3) interacting with others about the EBP implementation, and (4) becoming aware of EBP implementation and their own leadership. Most participants experienced the LOCI strategy as beneficial for implementing EBPs for PTSD in their clinic. The strategy succeeded in raising awareness of leadership for EBP implementation, and simultaneously provided participants with tools and support for leading the implementation in their clinic. Two participants experienced LOCI as less beneficial than the others. Our results support the strategy's potential to engage and empower first-level leaders to get involved in implementation processes and point to important challenges for future research on implementation strategies.

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.

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/ .

Measuring implementation climate: psychometric properties of the Implementation Climate Scale (ICS) in Norwegian mental health care services.

BackgroundEmployees' perceptions of organizational climate for implementation of new methods are important in assessing and planning for implementation efforts. More specifically, feedback from employees' points to which implementation strategies to select, adopt, and tailor in building positive climate for implementation of new evidence-based practices within the organization. Implementation climate can be measured with the Implementation Climate Scale (ICS). The purpose of this study was to investigate the psychometric properties of the Norwegian version of the ICS in outpatient mental health clinics.MethodsThe ICS was administered to 383 clinicians within 47 different child and adult mental health clinics across the country. We conducted confirmatory factor analysis to assess the psychometric functioning of the ICS. Cronbach's alpha was examined to assess internal consistency. We also examined criterion related validity of the scale by comparing it with an alternative measure of implementation climate (concurrent validity) and by examining correlations with clinicians' intentions to use evidence-based practices.ResultsResults supported the 6-factor structure and the internal consistency reliability of the ICS. One exception was poor functioning of the Reward scale. Concurrent validity was stronger at the group than at the individual level, and assessment of associations with clinicians' intentions to use evidence- based practices showed positive correlations.ConclusionsThe Norwegian version of the ICS is a promising tool for assessing implementation climate which can provide organizations with specific feedback concerning which aspects of the implementation climate to attend to. Due to poor functioning of the Reward scale, adaptations and further testing of this is recommended.

Good soldiers in implementation: validation of the Implementation Citizenship Behavior Scale and its relation to implementation leadership and intentions to use evidence-based practices.

BACKGROUND: Implementation citizenship behavior (ICB) describes extra-role behaviors performed by employees to support evidence-based practice (EBP) implementation. Such behaviors can be measured using the Implementation Citizenship Behavior Scale (ICBS), which divides ICB into two dimensions, namely helping others and keeping informed. The current study extends the use of the ICBS to a context outside the USA and adds to the literature by investigating how leader-perceived ICB relates to practitioner-perceived implementation leadership and practitioners' intentions to use EBPs. METHODS: Participants were 42 leaders and 152 practitioners in Norwegian mental health services implementing EBPs for post-traumatic stress disorder. Leaders rated each practitioner on ICB, and each practitioner rated their leader on implementation leadership and reported on their own intentions to use EBPs. The psychometric properties of the ICBS were assessed using confirmatory factor analysis and internal consistency reliabilities. The relationships between ICB, implementation leadership and intentions to use EBPs, were investigated through a series of bivariate correlation analyses and a path analysis of the total scales. RESULTS: The ICBS showed excellent psychometric properties. The hypothesized two-factor model provided an excellent fit to the data, and both subscales and the total scale were internally reliable. Leader-perceived ICB was positively and significantly correlated with both practitioner-perceived implementation leadership and practitioners' intentions to use EBPs. Correlations with intentions to use EBPs were stronger for the subscale of keeping informed than for the subscale of helping others. CONCLUSIONS: Results indicated that practitioners who rated their leader higher on implementation leadership received higher ICB ratings from their leader and reported higher intentions to use EBPs. The results provide evidence of a reciprocal social exchange relationship between leaders and practitioners during EBP implementation and a link to an important proximal implementation outcome (i.e., intentions to use EBPs). Results also suggest cultural differences in how ICB is perceived and relates to other phenomena. Scientific and practical implications are discussed. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials with ID NCT03719651 .

Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol.

BACKGROUND: Alignment across levels of leadership within an organization is needed for successful implementation of evidence-based practice. The leadership and organizational change for implementation (LOCI) intervention is a multi-faceted multilevel implementation strategy focusing on enhancing first-level general and implementation leadership while also engaging with organization upper management to develop an organizational climate for implementation. The aim of the project is to evaluate the effectiveness of LOCI in supporting the implementation of evidence-based treatment for PTSD in child- and adult-specialized mental health clinics in health trusts in Norway. METHODS: The study design is a stepped-wedge cluster randomized trial with enrollment of clinics in three cohorts. Executives, clinic leaders, and therapists will be asked to complete surveys assessing leadership and implementation climate. Surveys will be completed at baseline, 4, 8, 12, 16, and 20 months. Results from surveys will be shared with executives and clinic leaders to inform the subsequent creation of tailored leadership and climate development plans for enhanced implementation. Patients will complete surveys measuring traumatic events and post-traumatic stress symptoms during the therapy process. Therapy sessions will be audio or video recorded and scored for fidelity as part of training. DISCUSSION: This study aims to provide knowledge on how to improve leadership and organizational climate to enhance effective implementation of evidence-based treatments in mental health services. TRIAL REGISTRATION: The study has been registrated in ClinicalTrials with ID NCT03719651 .