Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

Document Type : Original Article


1 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden

2 Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

3 Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden

4 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

5 Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

6 School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

7 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

8 Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden

9 International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden

10 Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden

11 Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada


Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.
Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.
Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.
Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.


Main Subjects

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