Reducing the Burden of Evidence-Based Practices: The Roles of Leadership and Organizational Climate
Evidence-Based Practices (EBPs) are associated with favorable client outcomes, yet are still not widely implemented in community mental health treatment settings. Staff attitudes toward EBP have shown promise as a target for improving implementation efforts. Aarons et al. (2012) recently identified perceived burden—the extent to which staff view use of EBPs as an added hassle to their already heavy workload—as a dimension of attitudes toward EBP. The impact of perceived burden is twofold; staff who perceive EBPs as burdensome will be less likely to use them with clients, and may also be more likely to experience dissatisfaction and burnout as the demand for EBP use increases. Research has identified organizational factors such as leadership and climate as predictors of staff attitudes, but their association with perceived burden has not yet been explored. Therefore, the current study tests a two-level model in which we examine the impact of transformational leadership on empowering climate and demoralizing climates at the organizational level, then explore how these organizational factors are associated with individual staff members’ perceived burden of using EBPs.
Methods
The sample included 363 staff from mental health clinics in San Diego County, California. Perceived burden of use of EBPs was measured using the Burden subscale from the Evidence-Based Practice Attitudes Scale-50. Transformational leadership was measured using the Multifactor Leadership Questionnaire (α=.95), and empowering (α= .71) and demoralizing climates (α= .85) were measured using items from the Children’s Services Survey. Both leadership and climates were aggregated to the team level, while burden was analyzed at the individual level. A multilevel path analysis was conducted using MPLUS 7.11, accounting for missing data with Full Information Maximum Likelihood (FIML). The indirect effects of transformational leadership on burden through each of the organizational climates were tested using PRODCLIN 2.
Results
Results indicated significant relationships between transformational leadership and both empowering climate (β= .37, t= 6.47, p<.001) and demoralizing climate (β= -0.26, t= -2.70, p<.01), as well as a significant relationship between demoralizing climate and perceived burden of using EBPs (β= .55, t= 4.48, p<.001). In addition, the indirect effect of transformational leadership on burden through demoralizing climate was significant (95% CI = -0.252 - -0.041). Nearly all of the residual between-teams variance for burden was explained (β= 0.002, t= 0.03, p>.05), providing support for analyzing burden on the individual level.
Conclusions
Higher levels of transformational leadership were associated with increased empowering climate and decreased demoralizing climate. In addition, staff members on teams scoring lower on the demoralizing climate scale reported less perceived burden of using EBPs. Finally, higher levels of transformational leadership were associated with lower perceived burden through a decrease in demoralizing climate. These findings highlight the importance of targeting leadership and organizational climate when implementing EBPs in order to decrease staff perceived burden, improve the workplace, and enhance quality of client care.