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

Ane-Marthe Solheim Skar, Nora Braathu, Nadina Peters, Harald Bækkelund, Mathilde Endsjø, Aida Babaii, Randi Hovden Borge, Tore Wentzel-Larsen, Mark G Ehrhart, Marisa Sklar, C Hendricks Brown, Gregory A Aarons, Karina M Egeland, Ane-Marthe Solheim Skar, Nora Braathu, Nadina Peters, Harald Bækkelund, Mathilde Endsjø, Aida Babaii, Randi Hovden Borge, Tore Wentzel-Larsen, Mark G Ehrhart, Marisa Sklar, C Hendricks Brown, Gregory A Aarons, Karina M Egeland

Abstract

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/ .

Keywords: Evidence-based practice; Implementation climate; Implementation leadership; Implementation strategies; LOCI; Mental health; PTSD; Transformational leadership.

Conflict of interest statement

There are no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Staff-rated implementation leadership before and after the introduction of LOCI. Measure times − 3 to − 1 are the non-LOCI periods, while measure times 0 to 4 are the LOCI periods. Cohort 1 includes measure times − 1 to 4, cohort 2 includes measure times − 2 to 3, cohort 3 includes measure time − 3 to 2. The black line represents the estimated slope in the non-LOCI and LOCI periods. The large dots show the trajectories for each cohort (respectively) over time
Fig. 2
Fig. 2
Staff-rated transformational leadership before and after the introduction of LOCI. Measure times − 3 to − 1 are the non-LOCI periods, while measure times 0 to 4 are the LOCI periods. Cohort 1 includes measure times − 1 to 4, cohort 2 includes measure times − 2 to 3, cohort 3 includes measure time − 3 to 2. The black line represents the estimated slope in the non-LOCI and LOCI periods. The large dots show the trajectories for each cohort (respectively) over time
Fig. 3
Fig. 3
Staff-rated implementation climate (ICS) before and after LOCI. Measure times − 3 to − 1 are the non-LOCI periods, while measure times 0 to 4 are the LOCI periods. Cohort 1 includes measure times − 1 to 4, cohort 2 includes measure times − 2 to 3, cohort 3 includes measure time − 3 to 2. The black line represents the estimated slope in the non-LOCI and LOCI periods. The large dots show the trajectories for each cohort (respectively) over time
Fig. 4
Fig. 4
Staff-rated implementation climate (ICM) before and after LOCI. Measure times − 3 to − 1 are the non-LOCI periods, while measure times 0 to 4 are the LOCI periods. Cohort 1 includes measure times − 1 to 4, cohort 2 includes measure times − 2 to 3, cohort 3 includes measure time − 3 to 2. The black line represents the estimated slope in the non-LOCI and LOCI periods. The large dots show the trajectories for each cohort (respectively) over time
Fig. 5
Fig. 5
Staff-rated implementation climate among providers receiving training in screening only versus training in screening and EBP for PTSD treatment. Measure times − 3 to − 1 are the non-LOCI periods, while measure times 0 to 4 are the LOCI periods. Cohort 1 includes measure times − 1 to 4, cohort 2 includes measure times − 2 to 3, cohort 3 includes measure time − 3 to 2. The black line represents the estimated slope in the non-LOCI and LOCI periods. The large dots show the trajectories for each cohort (respectively) over time

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