Development and Pilot testing of a Leadership Module to Support Quality Improvement Teams in Nursing Homes

BackgroundLeadership is a critical lever for supporting implementation of practice change ideas intended to improve care. We need evidence-based leadership programs to help front-line providers meaningfully implement practice change in complex care settings. Part of the SHIFT intervention, this paper describes and pilot tests a leadership program module (LeaderSHIFT) that provides training and implementation coaching to front-line leaders, as one of several integrated facilitated supports designed to help front-line care teams meaningfully enact practice change. MethodsThe LeaderSHIFT program module was developed based on empirical work, relevant facilitation and transformational leadership theories, and principles of stakeholder co-design and feasible engagement. A pilot implementation study was conducted that examined several of Proctors (2011) implementation outcomes. ResultsLeaderSHIFT includes four interactive workshops plus two one-on-one coaching sessions designed to develop capacity in four areas of implementation leadership: (1) Self-awareness, (2) Motivate and inspire, (3) Facilitate learning capacity, and (4) Support team-oriented processes. Pilot results suggest it can be successfully implemented (it was acceptable, adopted, appropriate, feasible). Fidelity (LeaderSHIFT role enactment) varied across pilot teams. ConclusionsWith a strong theoretical and empirical base, LeaderSHIFT highlights important, often overlooked, relational and socio-cultural aspects of successful implementation leadership. As such, the LeaderSHIFT program module has the potential to improve implementation of practice change interventions in nursing homes and other institutional care settings. Trial registrationRegistered at ClinicalTrials.gov (ID NCT03426072) on July 18, 2022. KEY MESSAGES REGARDING FEASIBILITYO_LIWhat uncertainties existed regarding the feasibility? O_LIWhile leadership is known to be a critical lever for implementation of evidence-informed practice change, there are few leadership training programs that have a relational focus designed to support broader team-based practice change initiatives; and uncertainty remains regarding implementability (feasibility, acceptability, appropriateness, fidelity) of this type of leadership module in complex care settings C_LI C_LIO_LIWhat are the key feasibility findings? O_LIThe LeaderSHIFT module performed well on several key implementation outcomes (module acceptability, feasibility, appropriateness). Fidelity to implementation leadership was successful for managers who were able to enact relational aspects of the role. C_LI C_LIO_LIWhat are the implications of the feasibility findings for the design of the main study? O_LIFindings confirmed the value of one-to-one coaching for enhancing leaders relational competencies and prompted training overlap for senior and front-line leaders to ensure there is a common understanding of respective roles in intervention implementation. C_LI C_LI