News Studies

Multiple Levels of Leadership in Implementing Evidence-Based Practices in Health Care

Erick Guerrero
Delivery of evidence-based substance abuse treatment practices, such as contingency management treatment (CMT) and medication-assisted treatment (MAT), have been shown to improve treatment adherence and to reduce substance use. Yet, approximately less than 30 percent of addiction treatment programs have implemented MAT and less than half deliver CMT. One way to increase implementation of such evidence-based practices (EBP) at community-based addiction health service programs is through leveraging the influence of leaders. Leadership at different levels, including top and middle managers, has been shown by previous studies to be essential for ensuring implementation. Drawing on this, Dr. Erick Guerrero and his research team tested the relationship between top- and middle-level management styles and implementation of EBPs in addiction health service organizations. In a study published in Health Care Management Review, Dr. Guerrero and his team posited the following hypotheses:
  1. Top managers’ transformational leadership (i.e. the ability to inspire employees to follow a particular course of action) will be positively related to middle managers’ leadership in implementing EBPs (i.e. supporting staff).
  2. Top managers’ transformational leadership will then be indirectly related to employee (i.e. counselors) attitudes towards EBPs, through fostering the middle managers’ implementation leadership.
  3. Top managers’ transformational leadership will also be indirectly related to CMT and MAT implementation, through fostering middle managers’ implementation leadership.
The study’s evaluation was done by surveying 112 addiction health providers in 2013 that serve predominantly Latino and African-American residents of Los Angeles County, California. For each program, the team surveyed top managers, middle managers, and counselors. To measure the outcomes, the team asked about employee attitudes towards EBPs in the organization and the extent to which the provider had implemented CMT and/or MAT in their programming; responses ranged from never to always. Responses from middle managers and counselors to a set of questions were used to measure the transformational leadership of top managers, and another set of responses by counselors were used to measure the leadership for EBP implementation of middle managers. To evaluate the hypotheses, the research team used a method that accounts for the fact that responses from multiple individuals, top- and middle-level managers as well as counselors, within the same organization may be more similar than responses across different organizations. The method also allows them to track the relationship from top manager to middle manager to counselors. The researchers found the following:
  1. Transformational leadership from top managers was positively related to middle managers’ implementation leadership of EBPs.
  2. Transformational leadership from top managers was indirectly related to counselor attitudes of EBPs, by fostering higher middle managers’ implementation leadership.
  3. There was a minimal indirect positive relationship between transformational leadership and implementation of CMT (and no relationship to MAT), generated by fostering middle managers’ leadership.
Overall, the research team concluded that their findings show the importance of middle managers’ implementation leadership in transmitting the influence of directors’ transformational leadership on employee attitudes towards innovative practices. While not conclusive, it appears this can then indirectly lead to CMT implementation. The researchers could not make the same interpretations for implementing MAT, possibly because MAT is more expensive than CMT and hence more difficult to implement, which may mean that a different process is required to adopt MAT. To view the study in its entirety, please click here. Source: “Advancing Theory on the Multilevel Role of Leadership in the Implementation of Evidence-Based Health Care Practices”, Health Care Management Review

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