Background:

Clinical leadership is fundamental in facilitating service improvements in healthcare. Few studies have attempted to understand or model the different approaches to leadership which are used when promoting the uptake and implementation of evidence-based interventions. This research seeks to uncover and explain how distributed clinical leadership can be developed and improved to enhance the use of evidence in practice. In doing so, this study examines implementation leadership in orthopaedic surgery to explain leadership as a collective endeavour which cannot be separated from the organisational context.

Policy and Practice Partners:

We work closely with the British Orthopaedic Association, the British Hip Society and three NHS hospital Trusts who cannot be named due to ethical restrictions.

Co-Funding partners:

N/A

Aims and Objectives:

Aim: to understand and explain how distributed clinical leadership can be developed and improved to enhance the use of evidence in practice.

Objectives:

1. to perform realist synthesis to identify the variety of leadership models and interventions used in surgery and to provide an explanatory analysis of the most effective leadership approaches in the context of practice

2. to undertake interviews with orthopaedic surgeons at various career stages, timepoints and undertaking various leadership training programmes to explore relationships between performance, training and clinical leadership

4. to systematically map and analyse the leadership relationships and flows of information between individuals, groups and hospitals through observation and social network analysis at 3-6 hospitals

5. to integrate and triangulate data to develop interventions which enhance leadership strategies and training styles to encourage and enable clinicians to improve EBP

Methods:

The realist review will seek to answer the following question,’ How, to what extent and in which context can leadership in surgery be influenced? The review runs in parallel with a mixed-method study consisting of longitudinal and cross-sectional interviews and an embedded social network analysis. A series of repeated semi-structured interviews conducted over 4 years, with orthopaedic surgeons and their professional networks will be conducted. These longitudinal interviews will be supplemented by cross-sectional interviews with the national established surgical leaders and those undertaking leadership training programmes. All qualitative data will be analysed thematically and integrated with the quantitative data using a realist logic of analysis and programme theory developed in the realist review.

Main Results:

Current status year 2: we have developed the protocol and initial programme theory for the realist review which is undergoing peer review. The theoretical searches and screening are complete, and the team are moving onto the empirical searches to obtain data to develop context mechanism outcome configuration to test our initial programme theory. We have completed 37 interviews and over 50 hours of meeting observation.

Conclusions:

N/A at this stage

Implications for Implementation:

N/A at this stage

Protocol:

Grove, Amy L., Clarke, Aileen, Currie, Graeme, Metcalfe, Andrew J., Pope, Catherine, Seers, Kate, 2020. Advancing clinical leadership to improve the implementation of evidence-based practice in surgery: a longitudinal mixed-method study protocol. Implementation Science, 15 (1)

Publication:

Review protocol currently under review

Gauly J, Seers K, Currie G, Clarke A, Court R, Grove A. Improving leadership in surgery: A realist review protocol. Systematic Reviews. Under review.