BACKGROUND Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians' use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis. METHODS Using data collected at three waves over a 5-year period from a panel of 30 outpatient children's mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians' use of EBP. At each wave, clinicians reported on their first-level leaders' implementation leadership, their organization's EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates. RESULTS Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians' average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians' EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]). CONCLUSIONS When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership-EBP implementation climate mechanism.

中文翻译：

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测试战略实施领导力，实施环境和临床医生对循证实践的使用的理论：5年的小组分析。

背景技术实施理论表明，通过制定特定的领导行为（例如，积极主动，知识渊博，支持他人，持之以恒的态度），有时被称为中层管理人员的第一级领导者可以增加临床医生在医疗机构中对循证实践的使用。实施）在组织内部建立EBP实施环境；但是，需要进行纵向和准实验研究来检验这一假设。方法利用在5年期间从30个门诊儿童心理健康诊所的30个小组中聘用的496名临床医生收集的数据，我们进行了一项准实验差异研究，以检验组织内部变革的实施领导力是否能够预测组织内部在EBP实施环境方面的变化，EBP实施环境的变化是否预示了组织内临床医生使用EBP的变化。在每波浪潮中，临床医生都会报告其一级领导者的实施领导能力，组织的EBP实施环境以及他们对儿童精神病的EBP和非EBP心理治疗技术的使用情况。在组织级别使用计量经济学的双向固定效应回归模型对假设进行了测试，该模型控制了所有稳定的组织特征，结果随时间推移的人口趋势以及随时间变化的协变量。结果从实施领导水平从低到高改善的组织，其EBP实施环境水平显着增加（d = .92，p =）。017）和组织内部执行领导力的提高占EBP实施环境改善的方差的11％，超过所有其他协变量。反过来，从低到高的EBP实施环境改善的组织，其临床医生的平均EBP使用量显着增加（d = .55，p = .007），并且组织内EBP实施环境的改善占14％临床EBP使用量增加的差异。调解分析表明，实施领导力的改善通过改善EBP实施环境对临床医生的EBP使用具有显着的间接影响（d = 0.26，95％CI [.02至.59]）。结论当一级领导者增加实施领导行为的频率时，组织的EBP实施环境得到改善，反过来又有助于临床医生增加EBP的使用。需要测试以测试针对该实施领导力-EBP实施气候机制的策略。