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

Abstract

\n 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 trial enrolled 47 first-level leaders from child- and adult-specialized mental health clinics within Norwegian health trusts across three cohorts. All therapists (n = 804) received training in screening of trauma exposure and posttraumatic stress, and a subgroup (n = 249) of therapists received training in evidence-based treatment methods for posttraumatic stress disorder (PTSD). First-level leaders and therapists were asked to complete 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 engagement in the LOCI strategy would lead to greater therapist-rated scores on implementation leadership, transformational leadership, and implementation climate.Results: There was a significant increase in therapist-rated implementation and transformational leadership as well as implementation climate after the leaders were introduced to the LOCI strategy. This increase was sustained at all measurement time point compared to non-LOCI conditions which demonstrated a steady decrease in scores before LOCI was introduced. Conclusions: The LOCI strategy can develop better transformational and implementation leadership skills as well as contribute to a more positive implementation climate to enhance successful evidence-based practice implementation. Thus, LOCI can help leaders create an organizational context conducive for effective EBP implementation. Trial registration: NSD 60036/3/LH, NSD 60059/3/OOS The full trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/