ON-LINE ONLY SUPPLEMENTAL INFORMATION:
Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP:
Appendix 1: Key study definitions (see xxx, date)
Evidence: Knowledge derived from a variety of sources that has been subject to testing and has been found to be credible. This includes research, patient experiences and preferences, and practical knowledge and local data [e.g., audit, quality assessments, planning and project data] (xxx, date).Evidence-based practice (EBP): Practice derived from the best available evidence to achieve positive outcomes; this practice may range on a continuum from implementing a discrete practice (e.g., consistently using an evidence-based scale to assess the situation and implementing research-based interventions) to consistent ways or patterns of decision-making and practice [e.g., consistently seeking the best evidence in all decision-making to achieve positive outcomes] (xxx, date).
EBP activity/EBP-related activity: Various behaviors or decision-making approaches that clearly reflect use of evidence or groundwork related to EBP. For example, literature searches, identification of a need to question/search for evidence re: the basis for a current practice, participation in EBP-related groups/committees or projects (e.g., an evidence-focused QI project), championing an EBP practice change, writing evidence-based policies, EBP education, integrating an EBP into a treatment plan, etc.
Institutionalization of EBP: Integration of the use of evidence into the very fabric or structure and routine of a clinical organization. With institutionalization, EBP is an organizational norm (i.e., a routine way of doing things); and EBP has a pervasive presence as it is reflected in the culture, language, daily behaviors and in the organization’s infrastructure. Infrastructure consists of organizational structures, systems, roles, processes, relations, alignments, and capabilities (xxx, date).
Sustained change: Changes that endure over time, for example five or more years, based on deliberately created, continually monitored, and responsively refined actions as needed. EBP institutionalization or EBP as the norm reflects such a sustained change, wherein EBP-related activity has become a routine, sustained aspect of professional practice.
Appendix 2: Outline of core thematic groupings of leadership behaviors for EBP
Strategic: Macro behavioral themeo Planning/Organizing/Aligning for core EBP activation among staff and “leaders” (Mid-level theme)
Functional: Macro behavioral theme with six Mid-level themes and their Sub-themes
O INSPIRING/INDUCING:
· Rewarding/ recognizing
· Empowering
· Championing
· Articulating/ reinforcing expectations / O EDUCATING/DEVELOPING:
· Teaching/orienting
· Guiding/mentoring/ coaching/
Demonstrating / O ROLE
MODELING:
· Strategically enacting EBP
· Routinely enacting EBP / O INTERVENING
ACTIVELY:
· Leading
· Participating
· Supporting/being actively responsive / O MONITORING:
· Scanning/seeking/
observing
· Providing aggregate feedback on EBP progress / O IMPLEMENTING:
· Embedding in infrastructure
· Using interim interactive change methods
· Employing short-term, more passive change methods
Cross-Cutting: Macro “Behavioral” theme with three Mid-level themes:
o Strategic thinking
o Communicating
o Building & sustaining an EBP supportive culture
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Appendix 3: Tools & processes in the mid-level Functional leadership theme of Implementing specific EBP projects
Theme definition: Applying change interventions to enhance uptake and sustainability of specific evidence-based practices through targeted EBP change projects.Sub-themes and their activities related to implementation interventions/specific projects
Embedded Infrastructure Options to Enhance Change / Interim Interactive Change Methods / Short-term, More Passive Change Methods
· Ps: Policies/Procedures and related documentation forms; Protocols in the form of standing orders and standards of care
· Routine educational programming:
o Integrated within an Orientation session
o On-going Continuing education/Conferences/Grand rounds
· Structured general improvement methods: e.g.,
o Journal clubs
o Champion/groups
o E-B PDSA Process
o EBP Projects Process
o Audit/feedback for routine indicators
· General communication tools
o Agenda item at staff meetings
o Newsletters
o Reference manuals
o Documentation material
· Technology:
Electronic clinical reminders [Emerging] / · Engagement of key stakeholders; e.g., via creation of a project team, at times multidisciplinary
· Demonstration/pilot , perhaps with a PDSA or other model for projects
· Audit/feedback [not generic but for an individual project]
o With direct managerial expectations for action/ accountability
· Use of a short-term MD champion, opinion leader or expert
· Manual clinical reminders / · Posters/flyers/signs, posting in the bathroom
· E-mails
· Note in the paycheck
· Food
· Stickers; buttons; screen savers
· Special In-service
FREQUENT USE OF MULTIPLE METHODS
Appendix 4: Comparable research on leadership behaviors with conceptual categorizations
Task-oriented behaviors:
· Clarify roles and responsibilities
· Monitor performance and outcomes
· Modify care plans and documentation
· Procure resources, education, training & policies to reflect change
· Conduct regular leadership meetings
Relations-oriented behaviors
· Communicates with staff about clinical practice issues
· Recognize efforts to change
· Provide reminders
· Encourage & support collaboration with specialists and inter-professionals
· Support change visually and symbolically
Change-Oriented behaviors
· Demonstrate commitment to change
· Reinforce vision and goals of change
· Understand difficulties with change
· Advocate (champion) for change internally & externally
· Advocate for additionally resources internally & externally / Influencing organizational structures and processes.
· Ensures education and policy
Supports clinical champions
Facilitating staff to use the guidelines
· Provides support
· Is accessible & visible
· Communicates well
Creating a positive milieu of best practices
· Reinforces goals and philosophy
· Influences change
· Role models commitment / Supporting an organizational vision aligned to guideline implementation
· Establish guideline implementation as corporate objective
· Articulate support
· Attend planning and education sessions
· Encourage staff to implement the targeted guideline
Providing staffing and other resources
· Provide equipment & supplies
· Provide release time/ replacement support to enable education
Embedding the guideline in policy and procedures
· Embed in documentation systems / Cross-cutting leadership behaviors:
· Strategic thinking
· Communicating
· Building & sustaining an EBP supportive culture
Strategic leadership behaviors:
· Planning/Organizing/Aligning
Functional leadership behaviors:
· Intervening actively and involving one’s self in EBP Educating/developing
· Role modeling – strategically & routinely
· Inspiring and inducing –
· Implementing specific EBP projects
· Monitoring/providing feedback/seeking insights
For the most part, exact language from each study was used to enhance comparisons to L-EBP. / #See Appendix 2 for more details
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