Is leadership the key to implementing evidence into practice?

The importance of considering context when attempting to implement evidence into practice is becoming increasing apparent. Organisational culture (context) was found to influence the care provided in eight paediatric hospitals in Canada with contextual factors explaining many of the variations noted in practice (Estabrooks et al., 2011). A key element of the context is leadership. Leadership has been defined as:
The actions of formal leaders in an organisation to influence change and excellence in practice” (Estabrooks et al., 2009).

Leadership has been identified as key to ensuring evidence is used in practice (Gifford et al., 2007; Sandstrom et al., 2011). Indeed, resistant leadership and a lack of support from leaders may negatively impact on the use of evidence in practice (Hutchinson and Johnston, 2006; Newhouse et al., 2007). Leading with passion and persistence has been shown to support the uptake of nursing guidelines (Matthew-Maich et al., 2013). However, research regarding leadership activities that support the use of evidence in practice remains inconclusive (Sandstrom et al., 2011). Leadership attributes and qualities that appear to help change organisational culture and support the use of knowledge translation are:

• Valuing research – e.g. research incorporated into annual appraisal
• Knowledgeable about research
• Role-modelling evidence-based care
• Effective communicator
• Encouraging staff to question practice
• Staff involved in decision-making
• Supportive of changes in practice
• Providing feedback to staff
• Ensuring policy and procedures are evidence-based and kept up to date

(adapted from Sandstrom et al. 2011)

How authentic leadership impacts on staff performance and empowerment has been explored (Wong and Laschinger, 2013). Authentic leadership has been defined as:

A pattern of transparent and ethical leader behaviour that encourages openness in sharing information needed to make decisions while accepting input from those who follow.” (p.24) (Avolio et al., 2009).

The findings of this study revealed that the more managers are seen as authentic the more nurses perceive they have access to workplace empowerment structures, are satisfied with their work, and report higher performances. I suspect this also means nurses are more likely to feel able to question practice and implement evidence into practice.

If you are interested in finding out more about leadership in this context:

  • You can read an EBN commentary on the Wong and Laschinger paper at http://ebn.bmj.com/content/early/2013/07/18/eb-2013-101424.extract.
  • Look out for a commentary on the Matthew-Maich et al. paper that has just been sent to production and so will be online early soon.

You may also be interested in an editorial focusing on patient and public involvement (PPI) in research by Staniszewska et al. that will also be available soon and published in the October edition of the journal. Keep a look out on the EBN website (http://ebn.bmj.com/) or better still sign up for eTOCS (on the right hand side of the journal’s homepage).

References
Avolio BJ, Walumbwa FO and Webber TJ. (2009) Leadership: Current theories, research and future directions. Annual Review of Psychology 60: 421-449.

Estabrooks CA, Squires JE, Cummings GG, et al. (2009) Development and assessment of the Alberta context tool. BMC Health Services Research 9: 1-12.

Estabrooks CA, Squires JE, Hutchinson AM, et al. (2011) Assessment of variation in the alberta context tool: The contribution of unit level contextual factors and speciality in Canadian pediatric acute care settings. BMC Health Services Research 11: 1-17.

Gifford W, Davies B, Edwards N, et al. (2007) Managerial leadership for nurses’ use of research evidence: A integrative review of the literature. Worldviews on Evidence-Based Nursing Third Quarter: 126-145.

Hutchinson AM and Johnston L. (2006) Beyond the barriers scale: Commonly reported barriers to research use. Journal of Nursing Administration 36: 189-199.

Matthew-Maich N, Ploeg J, Dobbins M, et al. (2013) Supporting the uptake of nursing guidelines: What you really need to know to move nursing guidelines into practice. Worldviews on Evidence-Based Nursing 10: 104-115.

Newhouse RP, Dearholt S, Poe S, et al. (2007) Organizational change strategies for evidence-based nursing practice. Journal of Nursing Administration 37: 552-557.

Sandstrom B, Borglin G, Nilsson R, et al. (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.

Wong CA and Laschinger HKS. (2013) Authentic leadership, performance, and job satisfaction: The mediating role of empowerment. Journal of Advanced Nursing 69: 947-959.

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