Mixed Method Examination of Strategic Leadership for  Evidence-Based Practice Implementation

Friday 8:45 – 10:00 Symposium I

Presentor: Gregory Aarons

Gregory Aarons, UC San Diego; Amy Green, UC San Diego; Mark Ehrhart, San Diego State University; Elise Trott, Pacific Institute for Research and Evaluation; Cathleen Willging, Pacific Institute for Research and Evaluation


Leadership that supports effective evidenced-based practice (EBP) implementation is a critical concern. The recently developed Implementation Leadership Scale (ILS) is a valid and reliable 12-item scale with four subscales: proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. The ILS factor structure was developed using exploratory factor analysis (EFA) and supported using confirmatory factor analysis (CFA) with a sample of 459 mental health clinicians. In the current study, we analyzed quantitative and qualitative data from a large mixed-method study of EBP sustainment to examine the utility and structure of the ILS.  Participants included home visitors from 25 community-based organizations across ten child welfare service systems implementing the EBP SafeCare® to prevent child neglect.  Home visitors (n=190) completed the ILS as part of an annual web-survey during the same year qualitative focus groups (n=18) were conducted, focusing on implementation and sustainment of SafeCare.  During focus groups, home visitors were asked to respond to the prompt, “How have leaders influenced the ongoing use of SafeCare???? A CFA of the ILS confirmed the original factor structure.  Qualitative data supported the four ILS subscales. The theme of “accessible leadership??? emerged from the qualitative data and is an area for future research.



Implementing Practice Change in Federally Qualified Health Centers: Learning From Leaders’ Experiences

Friday 8:45 – 10:00 Symposium I

Presentor: Maria E. Fernandez

Maria E. Fernandez, School of Public Health, University of Texas Health Science Center – Houston; Nicholas H. Woolf, Henley Business School, at The University of Reading; Shuting (Lily) Liang, Rollins School of Public Health, Emory University; Natalia I Heredia, School of Public Health, University of Texas Health Science Center – Houston; Michelle Kegler, Rollins School of Public Health, Emory University; Michelle Carvalho, Rollins School of Public Health, Emory University ; Betsy Risendal, University of Colorado Cancer Center, Denver; Andrea Dwyer ,University of Colorado Cancer Center, Denver; Vicki Young. South Carolina Primary Health Care Association; Dayna Campbell , South Carolina Primary Health Care Association


We report on a qualitative study of 59 FQHC leaders who described their experiences of implementing both mandated and non-mandated evidence-based programs and practices.  Interviews were informed by the Consolidated Framework for Implementation Research (CFIR) and discussions guided by a modified Appreciative Inquiry approach to identify organizational strengths, values, motivations, and leaders’ vision of a transformed future. We first describe factors reported as most significant in supporting successful implementation of change, including: necessary and sufficient staff and leadership characteristics; the roles of mandates, financial consequences, and leaders’ personal passions in prioritizing change; and the significance of external relationships and collaborations. We then describe challenges not yet overcome that are yet amenable to intervention, including: staff knowledge and competence; the impact of practice change on existing provider and staff time constraints; and the continuing need for more automated and systematic procedures. We discuss lessons learned from both successes and on-going challenges, the interaction of individual and organizational factors in each area, and the incomplete integration and realization of potential of EMR in supporting practice change. We conclude with proposals for acting on the resulting levers of change to support further implementation of practice changes in the current FQHC climate.

Efficient Synthesis: Using Qualitative Comparative Analysis (QCA) and the CFIR Across Diverse Studies

Friday 8:45 – 10:00 Symposium I

Presentor: Laura Damschroder

Laura J. Damschroder, VA Ann Arbor Center for Clinical Management Research & Diabetes QUERI; Julie C. Lowery, VA Ann Arbor Center for Clinical Management Research & Diabetes QUERI



Syntheses are needed to understand what works where and why across diverse implementation studies. However, even with increasing numbers of published syntheses of organizational interventions, most highlight gaps in knowledge of contextual factors that influence implementation success. We synthesized findings from six implementation studies of different programs that that all systematically assessed context using the Consolidated Framework for Implementation Research (CFIR). QCA methods were used to analyze ratings and outcomes data from 44 Veterans Affairs medical centers. Findings reveal that organizations engaged in implementing change should establish formal systems for obtaining and discussing quantitative and qualitative feedback throughout implementation, regardless of the intervention being implemented.  When combined with good leadership, or good intervention design, or good networks and communications, its association with implementation success is even stronger. Use of a framework like the CFIR enabled a synthesis of multiple studies using QCA to identify key contextual factors related to success.  This approach is particularly important for the field of implementation research, where studies often suffer from small sample sizes.  The CFIR offers a means of standardizing definitions of key constructs across studies, while QCA acknowledges the causal complexity of context in implementation in a way that is impossible using traditional correlation-based statistical approaches.