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Pilot Feasibility Stud. 2019 Aug 19;5:103. doi: 10.1186/s40814-019-0485-7. eCollection 2019.

Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada.

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1Center for Research on Health and Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.
2Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada.
3Faculty of Medicine, Department of Medicine and Health, Linköping University, SE-581 83, Linköping, Sweden.
4School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.
5Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
6Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada.
7School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario Canada.
8Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario Canada.
9Department of Health Care Science, University of Gothenburg, Gothenburg, Sweden.
10Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.



Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants' engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.


We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.


Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0-4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.


The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.


Evidence-based practice; Fall prevention; Implementation leadership; Nursing; Residential care

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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