Implementing Clinical Guidelines for the Treatment of Psychosis: The Frontline Leaders' Point of View. A Qualitative Study.

Background: Despite the large amount of leadership and implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new knowledge. The questioning of conventional leadership approaches in healthcare organizations prompted us to investigate how frontline leaders comprehend their own implementation intentions and actions, and how these intentions and actions may impact the implementation of clinical guidelines in mental healthcare in Norway. Methods: Employing a theory-driven qualitative design, we conducted nine semi-structured interviews with frontline leaders who had recently led implementation of clinical guidelines for the treatment of psychosis in mental health. We employed Systematic Text Condensation, informed by Normalization Process Theory, to structure and analyze the data and used fidelity scales to measure the degree of implementation and distinguish between leaders' levels of success in implementation. Results: Frontline leaders in units that achieved high success in implementation described their intentions and actions differently, from those with less success. The former group's actions aligned more closely with the constructs of the Normalization Process Theory compared to the latter group when describing their actions. Frontline leaders leading units with a high degree of implementation success describe relation-orientation, trust, and providing adaptive space for staff members to take initiative. In contrast, those leading units with less implementation success describe more control and guidance of co-operators and place more emphasize on information and knowledge. Conclusion: Differences in how frontline leaders describe their actions and intentions to achieve clinical guideline implementation suggest that the leadership approach of these frontline leaders is an important factor to consider when planning and conducting implementation. To better understand the implementation process, it is important to pay attention to how frontline leaders customize their leadership approaches to the dynamics of complex organizations, and how they interact with their team and superiors.

Frontline leadership for implementing clinical guidelines in Norwegian mental health services: a qualitative study.

PURPOSE: The purpose of this study was to explore and interpret how frontline leaders define, experience and rationalise their approaches to the successful implementation of clinical guidelines in mental health care. DESIGN/METHODOLOGY/APPROACH: Employing an interpretative phenomenological design, the authors conducted and analysed individual interviews of frontline leaders at 14 psychiatric clinics involved in a national study of implementing evidence-based clinical guidelines in mental health. FINDINGS: The authors found a broad spectrum of attitudes and attributes, as well as a wide repertoire of strategies for frontline implementation leadership. Three main approaches were revealed, comprising "Curious and welcoming", "Integrity and setting standards" and "Caring and collegial". RESEARCH LIMITATIONS/IMPLICATIONS: The study present what experienced frontline leaders emphasise to enable implementation of guidelines, not empirical pieces of evidences for what they in fact do or if these actions lead to implementation. The generalisability to other settings is unknown. Another sample profile, context or organisational level may have impacted the result. The concreteness of the frontline leaders' considerations, approaches and actions gives important knowledge about frontline leaders leadership across traditional leadership theories. ORIGINALITY/VALUE: Existing leadership theories describe different leadership styles, while this study reveals the need for a wide range of approaches to balance the many needs and demands. The complexity of leadership approaches this study found is in line with implementation theories; thus, the present study incorporates implementation science into the leadership literature.

Memories of parental rearing and perceived self-image in groups of chronic pain patients.

OBJECTIVES: The aim of this study was to analyze the relationships between perceived parental rearing styles as determining factors of self-image in chronic pain patients, and to test the hypothesis of two different groups inherent to the pain sample. METHODS: In this study, 152 patients with chronic pain participated. The sample was divided into two groups by means of hierarchical cluster analysis on the Minnesota multiphasic personality inventory, version 2. Cluster 1 comprised 116 individuals (44 men and 72 women) with a "conversion V" MMPI-2 profile, and cluster 2 comprised 21 individuals (5 men and 16 women) with a "general elevated" MMPI-2 profile. The patients were investigated by means of the structural analysis of social behavior (SASB), the Giessen test (GT), the locus of control scale (LOC) and the EMBU questionnaire (My memories of parental upbringing). RESULTS: The results show significant associations between memories of parental rearing and self-image as adults and are in line with results from previous studies describing two psychologically different groups inherent to chronic pain patients. CONCLUSIONS: The significant differences between healthy controls, pain patients and between clusters of pain patients on parental rearing scales, and the significant relationship between memories of parental rearing and self-image provide therapists with a special approach to the treatment of chronic pain patients in accordance to social cognitive theories and the psychodynamic theoretical construct of introjection as an early process in the development of self-images.