Improving Implementation Leadership: Training Transformational & Transactional Leadership Behaviors. Anne Richter, PhD 1,2,3

1 Procome research group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden 2 Centre for Epidemiology and Community Medicine, Stockholm County Council 3 Department of Psychology, Stockholm University

The iLead project group & co-authors

Anne Richter 2

1 Procome research group, Medical Management Centre, Karolinska Institutet 2 Centre for Epidemiology and Community Medicine, Stockholm County Council 3 Department of Psychology, Stockholm University 4 Leadership, evaluation and organizational development research group, Medical Management Centre, Karolinska Institutet

The project was financed by AFA insurance.

Ass. Prof. Ulrica von Thiele Schwarz 13

PhD Caroline Lornudd 24 MSc Robert

Lundmark 1 MSc Rebecca Mosson 12

Ass. Prof. Henna Hasson 12

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The setting

§  In healthcare organizational change is common.

§  The Swedish Health and Medical Services Act (1982:763) requests that the most effective evidence-based methods are provided to secure the best quality care, patient safety and cost efficiency.

§  Changes to the work practices in line with national guidelines, new care plans etc

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The setting

§  However: à Two-third of these changes fail (Greenhalgh et al.,

2004). §  This is a problem!

à Patients do not receive the most updated care à Managers are overwhelmed and experience that they

do not have the right skills and support (Socialstyrelsen, 2012)

à Employees become frustrated with implementation efforts, loose motivation and the willingness to participiate

à Organizational efficiency is on the line

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What is important for implementation?

PARiHS1

CFIR2

Implementation driver3

1Kitson, Rycroft-Malone et al (2008), 2 Damschroder, Aron et al (2009), 3 Fixsen et al 2005 4 Aarons et al 2011

EPIS 4

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Which kind of leadership is important? §  Four literatur reviews on leadership in the implemenation

context 1.  Reichenpfader, U., Carlfjord, S. & Nilsen, P. (2015). Leadership in

evidence-based practice: a systematic review. Leadership in Health Services. à 17 studies focus on EBP

2.  Sandström, B., Borglin, G., Nilsson, R., & Willman, A (2011). Promoting the implementation of evidence-based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence-Based Nursing Fourth Quarter: 212-223.Ref 3 à 7 studies and EBP focus

3.  Gifford, W., Davies, B., Edwards, N., Griffin, P., Lybanon, V. (2007). Managerial leadership for nurses’ use of research evidence: An integrative review of the literature. World views on evidence-based nursing,4(3): 126–145. à 12 studies

4.  Ovretveit, J. (2010). Improvement leaders: What do they and should they do? A summary of a review of research. Quality and Safety in Health Care, 19, 490–492

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Full range leadership model

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Transformational leadership

Transactional leadership

Laissez Faire leadership

•  Idealized influence

•  Inspirational motivation

•  Individual consideration

•  Intellectual stimulation

•  Contingent reward

•  Management by exception

•  Laissez faire leadership

Avolio, 2011; Bass & Avolio, 1993

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Is general transformational and transactional leadership enough? §  If you are a transformational leader, that does not mean that you

support this specific implementation §  Not necessarily related to implementation §  Thereforeà domain specific leadership:

à Specifies leader behavior related to implemenation à Possibly stronger relations to possible outcomes

§  So fare this has not been investigated, with an exception for

Aarons, G.A., Ehrhart, M.G., & Farahnak , L.R. (2014). The Implementation Leadership Scale (ILS): Development of a Brief Measure of Unit Level Implementation Leadership. Implementation Science, 9:45.

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Aim:

§  Develop, conduct and evaluate an intervention that increases generic implementation leadership based on the full range leadership model

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Implemenation leadership intervention

é Implemenation leadership

é Implemenation klimat

Group processes Trust

Direction

é Knowledge

Skills

é Productivity Well-being

Time

à iLead intervention

§  Today’s aim: Described th intervention and present some preliminary results on the process data

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Sample

§  Recruitment in health care in Stockholm County •  Selection criteria:

•  Manager position in health care à first & second line

•  Stockholm Health Care Services (SLSO) •  A current implementation

•  Control group: 39 managers •  Intervention groups:

•  Group 1: individual managersà21 •  Group 2: managers from same divisionà 31

•  Here senior management also received an adapted intervention

•  Change agents received two seminars as well

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Pedagogical idea

§  Work with one’s own implementation object throughout the intervention

§  Short expert lectures §  Reflection in small groups and individually §  Group work §  Role-play §  Feedback from employees, i.e., 180-degree feedback §  Feedback from fellow participants §  Feedback from workshop leaders §  Concrete work and help with one’s own implementation process,

i.e., action plan & sustainability plan §  Work at home between the workshops §  Booster email between the workshops

11

Kolb DA. Experiential learning: experiences as the source of learning and development. Englewood Cliffs: Prentice Hall; 1984.

Anne Richter

Content of the iLead intervention

Workshop 1&2 Implementation & leadership & Feedback report

Workshop 3 Behavioral change, communication, action plan

Workshop 4 Handle resistance, action plan

Workshop 5 Sustainability & sustainability plan

Study protocol for this intervention: Richter A, von Thiele Schwarz U, Lornudd C, Lundmark R, Mosson R, Hasson H. iLead—a transformational leadership intervention to train healthcare managers’ implementation leadership. Implementation Science. 2016; 11:1-13.

Feedback report

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20162015June

Baselinesurvey

Follow-up 1survey

Follow-up 2surveyC

ontr

ol

Gro

up

JanNov/Dec Nov/Dec

Inte

rven

tion

Gro

up 1

Follow-up 2survey

Baselinesurvey

Follow-up 1survey

WS1&2

WS3 WS4 WS5

Inte

rven

tion

Gro

up 2

Baselinesurvey

Follow-up 1survey

Follow-up 2survey

WS1&2

WS3 WS4 WS5

WS 1

WS 2

WS 3

WS 4

WS 5

WS1

WS 1

= intervention for line managers= intervention for senior management= change agents participate

Notes:

Interviews

Interviews

Timeline

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Results

§  Was the intervention successful? §  Evaluation based on the model by Kierkpatrick

à 1. Reactionsà Process data*, interviews * à 2. Learningà Process data*, pre & post

questionnaires *, interviews * à 3. Behaviorà Process data*, pre & post

questionnaires *, interviews * à 4. Resultsà Pre & post questionnaires *,

interviews *

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Data source: * Manager * Manager and their employees

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Kirkpatrick, D.L. (1994). Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc.

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Intervention overall §  Workshop quality appraisalà 10 opposite adjective pairs

(1-10)1

1Fridrich et al. 2016

Manager ratings

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1.Reaction 2. Learning 3. Behavior 4. Results Evaluation

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§  Outcome expectancyà 2 items1

1Fridrich et al. 2016

Manager ratings

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1.Reaction 2. Learning 3. Behavior 4. Results Evaluation

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1homegrown

§  Perceived implementation leadership knowledgeà 6 items1 =Workshop 1

=Workshop 5

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1.Reaction 2. Learning 3. Behavior 4. Results Evaluation

Manager ratings

Results for knowledge: Timeà F(3,153)=6.15, p=.001

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§  Short scale on implementation leadership à 6 items 12

Based on 1Randall, Nielsen & Tvedt (2009) 2 Kelloway, Mullen, Francis (2006

=Workshop 1 =Workshop 5

Manager ratings

1.Reaction 2. Learning 3. Behavior 4. Results Evaluation

Results for leadership: Timeà F(3,134)=1.64, p=.18

Differences in the intervention groups

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1 2 3 4 5 6 7 8 9

10

Ws1 WS2/3 WS4 WS5

Difference in knowledge depending on the intervention

group

Intervention group 1= normal

Intervention group 2= contextualization

1 2 3 4 5 6 7 8 9

10

Ws1 WS2/3 WS4 WS5

Difference in leadership depending on the intervention

group

Intervention group 1= normal

Intervention group 2= contextualization

Results for knowledge: Timeà F(3,153)=6.15, p=.001 GroupàF(1,153)=8.38, p=.001

Results for leadership: Timeà F(3,134)=1.64, p=.18 GroupàF(1,134)=23.96, p=.001

1.Reaction 2. Learning 3. Behavior 4. Results Evaluation

Manager ratings

Discussion

§  Effects seem to go in the right direction §  Or? à Decrease in the the own ratings of leadership

§  Advantages and disadvantages of the two intervention groups à More dropoutà no support? à A lot of organizational challengesà hindering of the organizational

context? §  Future:

à  include different process factors in the analysis à  Investigate the employee ratings à  have a close look at the interviews

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THANK YOU!

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Anne.Richter@ki.se

For more detailed information about this intervention: Richter A, von Thiele Schwarz U, Lornudd C, Lundmark R, Mosson R, Hasson H. iLead—a transformational leadership intervention to train healthcare managers’ implementation leadership. Implementation Science. 2016; 11:1-13. For more detailed information about our reserach group: http://ki.se/en/lime/procome