Association between Direct Supervisors' Implementation Leadership and Provider Adoption of a New Practice

Background and Purpose: Leadership at all organizational levels is critical for successful translation of new practices into routine mental health services. In particular, leaders who are proactive, supportive, knowledgeable, and perseverant through implementation barriers have had success in helping providers improve their practice. In assessing leaders, both the leaders’ and staff members’ perspectives are important. The alignment between these two perspectives has accounted for more 37% of variation in staff performance. Direct supervisors are proximal to providers’ daily practice and have opportunities to influence adoption behavior within their interactions with providers. Still unknown is how these interactions between providers and their supervisors drive providers' practice adoption. The purpose of the current study is to examine 1) alignment between providers and their direct supervisors in ratings of the supervisors’ implementation leadership and 2) the association between alignment and adoption of a new practice.

Methods: This longitudinal correlational study drew from a criterion sample of providers (N=124) and supervisors (N=81) from 14 community mental health clinics participating in a multi-state NIMH-funded randomized controlled trial of person-centered care planning (PCCP). The intervention included 12-months of training and consultation in PCCP, a recovery-oriented practice targeting treatment planning. Two analytic samples were used to examine alignment amongst providers and their supervisors at baseline (N=124) and the association between alignment and PCCP adoption amongst a sub-sample of providers who received the intervention (N=44). Participants completed electronic surveys that included the implementation leadership scale (independent variable), person-centered care questionnaire (outcome variables), and demographic characteristics. Univariate and analyses of variance (ANOVA) examined supervisor-provider alignment. Generalized linear mixed (GLM) models examined associations with two outcome variables: adoption (posttest PCCQ score) and change (mean pre/posttest difference). Covariates included gender, race, and site as a random effect.

Results: The majority of the sample identified as female (71.77%) and white (61.29%). Participants reported an average of 10.24 years in the mental health field and 5.17 years at their current agency. 45.16% of participants attended college and 37.9% attended graduate school. The majority (75.79%) of providers were not aligned with their supervisors’ ratings. ANOVA found outcomes adoption (p<.10) and change (p<.05) varied across the alignment groups. GLM found the highest adoption was amongst providers with strong and aligned supervisors (M=4.75, SD=.25, SE=.10) while alignment and poor supervisory leadership significantly reduced adoption (b=-.608, SE=.26, p<.05). Change (b=.45, SE=.18, p<.05) was significantly higher for providers with a supervisor who rated themselves higher than providers as compared to lower.    

Conclusions and Implications: Study findings support the notion that supervisors are key for provider adoption of new practices and are consistent with research demonstrating the importance of both supervisor and provider perspectives. For supervisors who had strong implementation leadership as determined by both themselves and their staff, providers reported high rates and change in adoption behavior. In addition, findings indicate that ‘confident’ supervisors who rated their leadership highly predicted higher provider behavior change. Supervisory perceptual alignment with providers and confidence in their leadership are two potential mechanisms to support adoption of new practices amongst mental health providers.