Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.
Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.



Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.



Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.



Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.|Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.
Malin
M
Tistad
Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.|Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Susanne
S
Palmcrantz
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.|Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
Lars
L
Wallin
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Anna
A
Ehrenberg
Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Swede.|School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Christina B
CB
Olsson
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Göran
G
Tomson
Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Swede.|Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden.
Lotta Widén
LW
Holmqvist
International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden.
Wendy
W
Gifford
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
Ann Catrine
AC
Eldh
D001291:Attitude of Health Personnel; D057191:Capacity Building; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D010865:Pilot Projects; D011361:Professional Competence; D024382:Professional Role; D036301:Qualitative Research; D012047:Rehabilitation Centers; D013192:Staff Development; D020521:Stroke / Q000628:therapy
Evidence-Based Practice (EBP); Facilitation; Implementation; Leadership; Management; Stroke Rehabilitation
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