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21 – 30 of over 115000Elizabeth Morrow, Glenn Robert and Jill Maben
The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care…
Abstract
Purpose
The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations.
Design/methodology/approach
Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care™ in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.
Findings
Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of “good and bad” leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements.
Originality/value
This paper offers useful perspectives in understanding informal, emergent, developmental or shared “new” leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.
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Barbara Kelly, Carole Edgerton, Seonaid Graham, Elaine Robertson and Barry Syme
The purpose of this paper is to consider evidence on the effectiveness of preschool social and emotional interventions in preschool contexts and focuses on the application of an…
Abstract
Purpose
The purpose of this paper is to consider evidence on the effectiveness of preschool social and emotional interventions in preschool contexts and focuses on the application of an implementation framework described in relation to the Preschool Promoting Alternative Thinking Strategies (PATHS) curriculum. Active parent involvement and engagement were not included in the implementation but preschool establishments spontaneously involved parents or parents sought involvement, creating innovations in delivery and context. The need for structured parent involvement and its impact are considered in relation to evidence on integrated programmes and different models of parent involvement.
Design/methodology/approach
This paper reports on an interim evaluation of practitioners’ and parents’ experiences of the implementation processes, focusing on the involvement and engagement of parents.
Findings
Evidence for the rationale for parent engagement in this context is substantiated. The Preschool PATHS curriculum is known to impact on children’s social competence, problem behaviour and, in the early school context, attainment. However the programme does not target parent skill directly or address parent behaviours that may affect children’s social competence and behaviour. It is suggested that the programme needs to be extended to provide structured input for parents via training and information similar to that provided for practitioners. A pilot study using integrated parent training material and supported by an implementation framework is advised.
Originality/value
The paper describes a flexible, evidence-based framework supporting replicable processes useful to service providers across programmes and contexts. An “innovation” (a term used to describe deviations from programme fidelity or implementation standards) is explored which affected the creation of parallel parent involvement strategies but not the delivery of the programme itself which was carefully monitored. While adaptations and deviations are inevitable, some flag up areas where development or issues of contextual fit need to be addressed and might, as in this case, inform better integration of evidence and practice development.
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Haaveshe Ndeutalala Nekongo-Nielsen and Elizabeth Ndeukumwa Ngololo
Namibian principals are usually placed in leadership positions without orientation and are found to lack skills to supervise teachers in delivering instruction using the English…
Abstract
Purpose
Namibian principals are usually placed in leadership positions without orientation and are found to lack skills to supervise teachers in delivering instruction using the English language. Studies conducted elsewhere in the world found that effective school leadership is needed for the success of professional development programmes. The purpose of this paper is to explore principals’ lived experiences with regard to their roles in the implementation of the English Language Proficiency Programme (ELPP).
Design/methodology/approach
This paper followed a qualitative inquiry with multiple case study designs to explore principals’ lived experiences during the implementation of the ELPP. Ten schools were selected for the analysis, two from each of the five regions. The schools were selected on the basis of remoteness, the total number of teachers who participated in the ELPP, school phases (i.e. primary and combined) and pre-test scores. Principals were interviewed using exploratory open-ended questions, and data analysis produced five categories under which the results were presented.
Findings
The findings indicate that principals applied their individual logic to accommodate and implement the programme. They applied their individual productive leadership habitus to contextualise ELPP activities to ease their workload and appear corporative. Principals had significant influence on teacher learning and ensured successful implementation of a ministerial programme. Moreover, their leadership skills influenced the ways in which teachers received instruction and created a conducive learning environment. Owing to principals’ administrative, instructional and transformational leadership, many teachers participated and transcended upward and some were declared proficient in English.
Research limitations/implications
This study research the effectiveness of leadership regarding English professional development programmes in achieving goals, explore power relations between school principals and education officials when developing and implementing professional development programmes and establish more efficient ways of providing a better leadership model for professional development programmes to achieve goals.
Practical implications
This paper was limited to a few principals at rural schools in selected regions, therefore findings could not be generalised.
Social implications
There is a need for creating opportunities for interactions among all stakeholders who are involved in the development and implementation of English proficiency programmes and to build power relations and work as a team to benefit schools. In order to enhance programme implementation and improve learning outcomes, there is also a need to provide feedback at intervals and find solutions to challenges as a team.
Originality/value
Placing principals in situations without orientation triggered the need for specific leadership logic and particularities to be applied in a context for the success of the programme, which resulted in participation of more teachers in the ELPP. They applied their particularities and productive habitus through administrative, instructional and transformational leadership to enhance learning. Principals appointed English language teachers to instruct and mentor others, and consequently enabled some principals and teachers to exit the programme. Principals achieved these short wins upon realising that one has to cooperate with the authority to ensure achieving desired outcomes.
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Clemens Hosman, M. Claire and L. Engels
This article discusses the state of the art concerning the meaning and value of model programmes in mental health promotion and mental disorder prevention. Model programmes are…
Abstract
This article discusses the state of the art concerning the meaning and value of model programmes in mental health promotion and mental disorder prevention. Model programmes are considered an important instrument for improving the quality, social impact and cost‐effectiveness of promotion and prevention. However, there is a lack of conceptual clarity and insight in the processes and mechanisms for successful use of model programmes in this field. This article offers a further clarification of the concept of model programmes and discusses its pros and cons and current views on the process of programme development and programme use. The discussion will be based particularly on recent experiences with model programmes in Europe. Until recently, prevention research was directed mainly at the design and testing of new model programmes. However, successful use of the ‘model programme strategy’ requires more attention to the pre‐conditions for effective dissemination, adoption and implementation of model programmes. Only when this multi‐phased process is taken into account and the required pre‐conditions and quality criteria are specified can one expect that model programmes will be more effective at a community level. The consequences of this view for prevention science and prevention research policies are discussed. To implement such a multi‐phased process successfully, not only are conceptual clarity and a scientific underpinning crucial, but also collaborative organisational structures are needed at national and international level if the range of complementary tasks is to be executed effectively and efficiently.
Michele S.Y. Kok, Mat Jones, Emma Solomon-Moore and Jane R. Smith
The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme…
Abstract
Purpose
The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes.
Design/methodology/approach
This fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence.
Findings
Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings.
Originality/value
An appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.
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Elizabeth Morrow, Glenn Robert, Jill Maben and Peter Griffiths
This paper aims to focus on facilitating large‐scale quality improvement in health care, and specifically understanding more about the known challenges associated with…
Abstract
Purpose
This paper aims to focus on facilitating large‐scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care™ programme in English hospitals.
Design/methodology/approach
The study upon which the paper draws was a mixed‐method evaluation that aimed to capture the perceptions of three main stakeholder groups: national‐level policymakers (15 semi‐structured interviews); senior hospital managers (a national web‐based survey of 150 staff); and healthcare practitioners (case studies within five hospitals involving 58 members of staff). The views of these stakeholder groups were analysed using a diffusion of innovations theoretical framework to examine aspects of the innovation, the organisation, the wider context and linkages.
Findings
Although The Productive Ward was widely supported, stakeholders at different levels identified varying facilitators and challenges to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments.
Research limitations/implications
To support implementation, policymakers should focus on expressing what can be gained locally using success stories and guidance from “early adopters”. Service managers, clinical educators and professional bodies can help to spread good practice and encourage professional leadership and support. Further research could help to secure support for the programme by generating evidence about the innovation, and specifically its clinical effectiveness and broader links to public expectations and experiences of healthcare.
Originality/value
This paper draws lessons from the implementation of The Productive Ward programme in England, which can inform the implementation of other large‐scale programmes of quality improvement in health care.
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Robert Holmberg, Mats Fridell, Patrick Arnesson and Mia Bäckvall
This paper seeks to investigate the role of leadership styles in the implementation of evidence‐based treatment methods (EBP) for drug abuse and criminal behaviour.
Abstract
Purpose
This paper seeks to investigate the role of leadership styles in the implementation of evidence‐based treatment methods (EBP) for drug abuse and criminal behaviour.
Design/methodology/approach
The paper employs a triangulation approach through mail questionnaires to 112 treatment personnel (49 per cent response rate), interviews with 65 employees and managers, observations and feedback workshops.
Findings
Responses from treatment personnel involved in the implementation of EBP indicated that their views on their immediate superior's leadership behaviour was significantly related to the perceptions of organisational innovative climate, job satisfaction and work output. Problems with workload, lack of collegial and managerial support and a low priority given to the programmes and treatment integrity were the most common barriers to implementation of the programmes. Effective managers were providing space, time and opportunity for the staff to perform their treatment‐related tasks and to be creative during the implementation process. This functional space had to be continually protected, both vertically from demands from higher levels of the organisation and horizontally from non‐helpful colleagues.
Research limitations/implications
The correlational design used in this study does not permit conclusions about causality.
Practical implications
Implementation of evidence‐based treatment programmes in clinical settings should pay attention to the impact of leadership styles on the experiences of treatment staff (climate, job‐satisfaction, burnout) and programme outcome. These variables should also be considered in the evaluation of treatment effects. The process of implementation can be seen as a route for learning and innovation, and managers should pay attention to the facilitation of these processes.
Originality/value
The role of leadership in implementation concerns not only production and structure but also learning, creativity and persistency during the process. The triangulation approach in this study also sheds light on the limitations of questionnaires in capturing the dynamics of leadership in human service organisations.
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Margaret M. Barry, Aleisha Mary Clarke and Katherine Dowling
The purpose of this paper is to provide a critical perspective on the international evidence on promoting young people’s social and emotional well-being in schools. The challenges…
Abstract
Purpose
The purpose of this paper is to provide a critical perspective on the international evidence on promoting young people’s social and emotional well-being in schools. The challenges of integrating evidence-based interventions within schools are discussed and the need for innovative approaches to research and practice are considered in order to support more sustainable approaches that can be embedded into the everyday practice of school systems.
Design/methodology/approach
A common elements approach to intervention development and implementation is explored. A case study is presented on piloting this approach with post-primary students, based on consultations with students and teachers concerning their needs in supporting youth social and emotional well-being.
Findings
The integration and sustainability of evidence-based social and emotional skills programmes within the context of whole school systems is far from clearly established. Research on the use of a common elements approach to evidence-based treatment and youth prevention programmes is presented and the application of this method to the development and implementation of social and emotional learning interventions is considered. Preliminary case study findings are presented exploring this approach in school-based intervention development for post-primary school students.
Research limitations/implications
The potential of adopting a common elements approach is considered; however, more rigorous research is needed to identify the most potent strategies for social and emotional skills development.
Originality/value
Identifying a common set of evidence-based strategies for enhancing adolescents’ social and emotional skills could lead to innovative approaches to intervention delivery that would extend the impact and reach of evidence-based practice across diverse educational systems and school settings.
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This paper describes the development of an evaluation framework to document the process, impact and outcomes of a community‐based mental health promotion project. This initiative…
Abstract
This paper describes the development of an evaluation framework to document the process, impact and outcomes of a community‐based mental health promotion project. This initiative, the Rural Mental Health Project, is concerned with the promotion of positive mental health in rural communities in the Republic and Northern Ireland. As a community‐based initiative, this project involves multi‐component interventions that are implemented with diverse target groups across a range of community settings. Assessing the process of programme implementation is critical in order to capture and document the realities of programme planning and implementation. The evaluation approach adopted in this project is based on a logic model research paradigm (Scheirer et al, 1995). This model gives equal emphasis to process and outcome evaluation and seeks to relate the realities of programme implementation to intended programme outcomes. Project activity is tracked prospectively in order to examine the detail of actual programme delivery and its influence on expected project outcomes. This paper outlines the model as applied in this project and explores the methodological and practical challenges in evaluating complex community interventions.
Elaine Aspinwall and Maged Elgharib
The purpose of this paper is to ascertain how total productive maintenance (TPM) has been implemented in large and medium size UK manufacturing companies, focusing on why such a…
Abstract
Purpose
The purpose of this paper is to ascertain how total productive maintenance (TPM) has been implemented in large and medium size UK manufacturing companies, focusing on why such a programme was introduced, the activities involved, and the effectiveness and difficulties encountered during the process.
Design/methodology/approach
The aspects listed were based on a review of the literature. A case study approach was favoured to collect the necessary data. Companies were contacted, four of which responded favourably, and a protocol was developed to enable interviews to be carried out at each.
Findings
“Culture” was highlighted as the main obstacle to successfully implementing TPM; others were lack of awareness about the advantages of the programme, low employee skills and high cost. Two benefits gained by the four companies were a significant improvement in the availability and performance of the equipment within the plant and improved communication between employees. Additional benefits were financial improvement, reduced energy cost and increased employee morale and job satisfaction.
Research limitations/implications
The number of companies that were willing to take part in the study was poor, thereby making it difficult to generalise the conclusions.
Practical implications
The results should help large and medium size organisations to better understand the TPM discipline, to facilitate its adoption and prioritise its practice. They also highlight the effectiveness and obstacles that can be encountered during the process.
Originality/value
The paper highlights the strong potential of TPM implementation programmes in affecting organisational performance improvements. The study also offers a beneficial source of information to organisations, which are still lagging far behind when it comes to TPM practices.
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