Abstract：
BACKGROUND: Evidence-based practice (EBP) implementation represents a strategic change that requires alignment of leadership and support throughout organizations. Leadership and Organizational Change for Implementation (LOCI) is a multifaceted implementation strategy that aims to improve implementation leadership and climate within organizations through iterative cycles of leadership and climate assessment and feedback, leadership training and coaching, and strategic planning with upper-level leaders. This study tested the effects of LOCI on transformational and implementation leadership, implementation climate, implementation citizenship behavior, and EBP reach.
METHODS: A multiple cohort, cluster randomized trial tests the effect of LOCI in 60 clinics across nine behavioral health organizations in California and Arizona, USA. The study randomized clinics within organizations to either LOCI or a leadership training webinar control condition in three consecutive cohorts. Repeated web-based surveys of direct service providers (nLOCI = 201, nControl = 179) assessed leadership, implementation climate, and implementation citizenship over time. Multilevel autoregressive modeling was the primary statistical analysis such that providers (level-1) were nested within clinics (level-2). The study predicted between-condition differences at 4-, 8-, and 12-month follow-up assessments. Provider engagement in a fidelity monitoring process assessed reach of motivational interviewing (i.e., number of sessions recorded/submitted for fidelity coding). An independent sample t-test explored between condition differences in motivational interviewing reach.
RESULTS: Results indicated between condition differences at 4 months for implementation leadership, implementation climate, and implementation citizenship behavior such that greater improvements were evidenced in the LOCI condition compared to the control condition. Reach of MI was significantly greater in the LOCI vs control condition such that LOCI providers were significantly more likely to engage in the fidelity monitoring process (chi-square (1, n = 370) = 5.59, p = .018).
CONCLUSIONS: LOCI was developed based on organizational theories of strategic leadership and climate to affect organizational change processes that communicate that innovation implementation is expected, supported, and recognized as a value of the organization. The LOCI implementation strategy resulted in more positive hypothesized outcomes compared to the control condition. Organizational change strategies have utility for implementing health innovations in complex, multilevel contexts and for greater sustainment of facilitative leader behaviors, strategic implementation climate, and improved implementation outcomes.
BACKGROUND: This study is registered with Clinicaltrials.gov gov (NCT03042832, 2 February 2017; retrospectively registered).
METHODS: A multiple cohort, cluster randomized trial tests the effect of LOCI in 60 clinics across nine behavioral health organizations in California and Arizona, USA. The study randomized clinics within organizations to either LOCI or a leadership training webinar control condition in three consecutive cohorts. Repeated web-based surveys of direct service providers (nLOCI = 201, nControl = 179) assessed leadership, implementation climate, and implementation citizenship over time. Multilevel autoregressive modeling was the primary statistical analysis such that providers (level-1) were nested within clinics (level-2). The study predicted between-condition differences at 4-, 8-, and 12-month follow-up assessments. Provider engagement in a fidelity monitoring process assessed reach of motivational interviewing (i.e., number of sessions recorded/submitted for fidelity coding). An independent sample t-test explored between condition differences in motivational interviewing reach.
RESULTS: Results indicated between condition differences at 4 months for implementation leadership, implementation climate, and implementation citizenship behavior such that greater improvements were evidenced in the LOCI condition compared to the control condition. Reach of MI was significantly greater in the LOCI vs control condition such that LOCI providers were significantly more likely to engage in the fidelity monitoring process (chi-square (1, n = 370) = 5.59, p = .018).
CONCLUSIONS: LOCI was developed based on organizational theories of strategic leadership and climate to affect organizational change processes that communicate that innovation implementation is expected, supported, and recognized as a value of the organization. The LOCI implementation strategy resulted in more positive hypothesized outcomes compared to the control condition. Organizational change strategies have utility for implementing health innovations in complex, multilevel contexts and for greater sustainment of facilitative leader behaviors, strategic implementation climate, and improved implementation outcomes.
BACKGROUND: This study is registered with Clinicaltrials.gov gov (NCT03042832, 2 February 2017; retrospectively registered).
摘要：
背景：基于证据的实践（EBP）的实施代表了一种战略变革，需要在整个组织中协调领导和支持。实施领导力和组织变革（LOCI）是一项多方面的实施战略，旨在通过领导力和气候评估与反馈的迭代循环来改善组织内部的实施领导力和气候。领导力培训和指导，和高层领导的战略规划。这项研究测试了LOCI对变革和实施领导的影响，实施气候，实施公民行为，和EBP到达。
方法：多队列，集群随机试验在加利福尼亚州和亚利桑那州的9个行为健康组织的60个诊所中测试了LOCI的效果，美国。该研究将组织内的诊所随机分配到连续三个队列中的LOCI或领导力培训网络研讨会控制条件。对直接服务提供商的重复基于网络的调查（nLOCI=201，nControl=179）评估了领导力，实施气候，随着时间的推移，实施公民身份。多级自回归模型是主要的统计分析，这样提供者（1级）嵌套在诊所（2级）内。这项研究预测了4-之间的条件差异，8-,和12个月的随访评估。提供者在保真度监测过程中的参与度评估了动机性访谈的范围(即，为保真度编码记录/提交的会话数)。独立样本t检验探讨了动机访谈范围的条件差异。
结果：结果显示实施领导在4个月时的情况差异，实施气候，和实施公民行为，因此与对照条件相比，LOCI条件的改善更大。与对照条件相比,在LOCI条件下MI的达到显著更大,使得LOCI提供者更有可能参与保真度监测过程(卡方(1,n=370)=5.59,p=.018)。
结论：LOCI是基于战略领导和气候的组织理论开发的，旨在影响组织变革过程，这些过程传达了预期的创新实施，支持,并被认为是组织的价值。与对照条件相比，LOCI实施策略产生了更积极的假设结果。组织变革战略对于在复杂的环境中实施健康创新具有效用，多层次的环境，为了更好地维持促进型领导者行为，战略实施环境，和改善实施成果。
背景：本研究已在Clinicaltrials.govgov注册（NCT03042832，2017年2月2日；回顾性注册）。
方法：多队列，集群随机试验在加利福尼亚州和亚利桑那州的9个行为健康组织的60个诊所中测试了LOCI的效果，美国。该研究将组织内的诊所随机分配到连续三个队列中的LOCI或领导力培训网络研讨会控制条件。对直接服务提供商的重复基于网络的调查（nLOCI=201，nControl=179）评估了领导力，实施气候，随着时间的推移，实施公民身份。多级自回归模型是主要的统计分析，这样提供者（1级）嵌套在诊所（2级）内。这项研究预测了4-之间的条件差异，8-,和12个月的随访评估。提供者在保真度监测过程中的参与度评估了动机性访谈的范围(即，为保真度编码记录/提交的会话数)。独立样本t检验探讨了动机访谈范围的条件差异。
结果：结果显示实施领导在4个月时的情况差异，实施气候，和实施公民行为，因此与对照条件相比，LOCI条件的改善更大。与对照条件相比,在LOCI条件下MI的达到显著更大,使得LOCI提供者更有可能参与保真度监测过程(卡方(1,n=370)=5.59,p=.018)。
结论：LOCI是基于战略领导和气候的组织理论开发的，旨在影响组织变革过程，这些过程传达了预期的创新实施，支持,并被认为是组织的价值。与对照条件相比，LOCI实施策略产生了更积极的假设结果。组织变革战略对于在复杂的环境中实施健康创新具有效用，多层次的环境，为了更好地维持促进型领导者行为，战略实施环境，和改善实施成果。
背景：本研究已在Clinicaltrials.govgov注册（NCT03042832，2017年2月2日；回顾性注册）。
