ArticleBMJ quality & safety2025
'We listened and supported and depended on each other': a qualitative study of how leadership influences implementation of QI interventions.
Article in BMJ quality & safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Who chooses to engage? Understanding the characteristics of physicians who voluntarily engage with an audit and feedback intervention: a retrospective cohort study.BMJ quality & safety · 2026Article
- Beyond the report: a qualitative exploration of safety incidents in maternity services.BMJ open quality · 2026Article
- Conducting rigorous implementation evaluations in real word settings: lessons from a consensus approach to perioperative pathway implementation for elective surgery.Implementation science communications · 2026Article
- The Palliative Aged Care Outcomes Program (PACOP): establishing a national framework to improve palliative care in long-term care facilities for older people.BMC geriatrics · 2026Article
- Implementing clinical practice guidelines into action: a qualitative study of managing knowledge translation in primary care organisations.Health research policy and systems · 2025Article
- Improving therapeutic engagement and observations on inpatient mental health wards in the English National Health Service: lessons from using quality improvement to scale up interventions.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Reconciling Safety and Safeguarding in Health and Social Care: Implications for Just Culture.Healthcare (Basel, Switzerland) · 2025Article
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is growing recognition in the literature of the 'Herculean' efforts required to bring about change in healthcare processes and systems. Leadership is recognised as a critical lever for implementation of quality improvement (QI) and other complex team-level interventions; however, the processes by which leaders facilitate change are not well understood. The aim of this study is to examine 'how' leadership influences implementation of QI interventions.
methodsWe drew on the leadership literature and used secondary data collected as part of a process evaluation of the Safer Care for Older Persons in residential Environments (SCOPE) QI intervention to gain insights regarding the processes by which leadership influences QI implementation. Specifically, using detailed process evaluation data from 31 unit-based nursing home teams we conducted a thematic analysis with a codebook developed a priori based on the existing literature to identify leadership processes.
resultsEffective leaders (ie, those who care teams felt supported by and who facilitated SCOPE implementation) successfully developed and reaffirmed teams' commitment to the SCOPE QI intervention (theme 1), facilitated learning capacity by fostering follower participation in SCOPE and empowering care aides to step into team leadership roles (theme 2) and actively supported team-oriented processes where they developed and nurtured relationships with their followers and supported them as they navigated relationships with other staff (theme 3). Together, these were the mechanisms by which care aides were brought on board with the intervention, stayed on board and, ultimately, transplanted the intervention into the facility. Building learning capacity and creating a culture of improvement are thought to be the overarching processes by which leadership facilitates implementation of complex interventions like SCOPE.
conclusionsResults highlight important, often overlooked, relational and sociocultural aspects of successful QI leadership in nursing homes that can guide the design, implementation and scaling of complex interventions and can guide future research.
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