The role of leadership in implementing and sustaining an evidence-based intervention for osteoarthritis (ESCAPE-pain) in NHS physiotherapy services: a qualitative case study

Abstract

Purpose

To explore the role of leadership by physiotherapists in implementing and sustaining an evidence-based complex intervention (ESCAPE-pain) for osteoarthritis.

Materials and methods

A qualitative case study approach using in-depth interviews with 23 clinicians and managers from 4 National Health Service (NHS) physiotherapy providers in England between 2016 and 2017. Data were analysed using thematic analysis.

Results

Different leadership roles and actions were characterised with four themes: (1) Clinical champions – clinicians driving the sustainability of ESCAPE-pain; (2) Supporters – junior clinicians directly supporting clinical champions’ efforts to sustain ESCAPE-pain; (3) Senior Manager – clinical champions’ senior managers influence on sustainability; (4) Decision-making – (in)formal processes underpinning decisions to (not) sustain the programme.

Conclusions

The study characterises the role of leadership in physiotherapy to sustain an evidence-based intervention for osteoarthritis (OA) within the NHS. Sustaining the intervention required on-going leadership, it did not stop at implementation. Senior specialist physiotherapists (as Champions) had a critical leadership role in driving sustainability. Their structural position (bridging the operational and strategic) and personal attributes allowed them to integrate different levels of leadership (i.e., senior managers and operational staff) to mobilise the collective, on-going work required for sustaining the programme.

IMPLICATIONS FOR REHABILITATION

• Senior managers and clinicians in practice settings need to be aware that sustaining an intervention is an on-going, collective effort that continues post-implementation.

• Senior managers need to enable senior clinicians (who straddle strategic and operational functions) to have sufficient autonomy to access and mobilise resources and scope to restructure local systems and practice to support intervention sustainability.

• Operational staff need to be supported to have the practical know-how to deliver evidence-based intervention, which includes instilling the value of and a commitment for the interventions.

• Managers need to utilise dispersed leadership to empower and enthuse frontline clinicians to participate fully in the work to refine and sustain interventions, because it cannot be achieved by lone individuals.

Keywords:

• Implementation
• evidence-based intervention
• osteoarthritis
• sustainability
• leadership

Acknowledgements

The authors would like to thank all those who participated in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Research and ethical approval were obtained from the Faculty of Health, Social Care and Education Research Ethics Committee at St George’s, University of London and Kingston University and the NHS (ref: 15.0156).