![]() Despite growing evidence of the importance of feedback for EBP implementation, there has been relatively little focus on practitioner attitudes toward feedback in mental health settings. We examined how transformational leadership and LMX may work together or independently to influence practitioners’ attitudes toward feedback to support EBP delivery. This study examined both transformational leadership and LMX as they relate to each other and to practitioners’ attitudes toward feedback ( 48, 49). Moreover, transformational leadership may be ‘personalized’ through the individual exchanges that build LMX ( 45, 47). Conversely, supervisor-employee interaction (i.e., LMX) may be necessary for the impact of transformational leadership to fully emerge ( 42, 43, 46). ( 45) suggest that transformational leaders nurture higher-quality LMX because their charismatic appeal makes employees more receptive to interaction. Researchers have called for more integrated studies of transformational leadership and LMX on the basis of evidence that the two leadership dimensions complement and influence each other ( 41– 45). ![]() However, outside of the context of EBP implementation, research has consistently demonstrated a correlation between LMX and staff perceptions about supervision, reception to general feedback, and feedback-seeking behavior ( 20, 36– 40). Research on LMX and implementation of EBPs is limited, with the exception of a study by Aarons and Sommerfeld ( 35) that found no significant association between LMX and attitudes toward EBPs. Low- LMX relationships are based on economic exchange and characterized by formal agreements and tit-for-tat mentality ( 30, 31), whereas high-LMX relationships are more social in nature and characterized by reciprocity, support, and commitment ( 32– 34). LMX theory focuses on the dyadic relationships between leaders and followers, and on how social exchanges create and sustain the quality of such relationships ( 29). Transformational leadership has been shown to have a positive association with practitioners’ attitudes toward EBPs during implementation, and it has been linked to feedback-seeking behavior and use of supervision ( 12, 19, 24– 28). Transformational leaders inspire employees to follow a particular course of action by considering individual employees’ unique talents, stimulating new ways of thinking and solving problems, and creating a shared vision and sense of purpose among employees ( 22, 23). This study examined supervisor transformational leadership because of its focus on creating a vision and buy-in for strategic initiatives such the implementation of EBPs and its promising role in previous implementation studies ( 12). ![]() The full range leadership model developed by Bass and Avolio ( 22) identified several dimensions of leadership behaviors, with the transactional and transformational styles being the most effective and well-researched. Transformational leadership theory and leader-member exchange (LMX) theory, two of the most influential theories in the business and management literatures, describe how leadership affects team and employee performance ( 21). Supervisory leadership behavior may influence practitioners’ willingness to seek out feedback and to apply it when it is given ( 19, 20). Inherent in these interventions is the assumption that practitioners are open to feedback, but individual attitudes toward feedback may vary. For example, audit and feedback interventions can improve implementation by highlighting discrepancies between practitioners’ current practice and their target performance and creating an action plan for improvement ( 17, 18). A growing body of research is investigating how targeted, ongoing feedback that is relevant to practitioner needs can be used to improve the implementation of EBPs ( 2, 4, 14– 16). However, a supervisor’s leadership behavior may play a key role in influencing practitioners’ attitudes toward receiving supervisory feedback to support EBP delivery ( 11, 12).įeedback is an important component of efforts to improve quality of care ( 13). Appropriate supervision improves practitioners’ views about EBPs, increases fidelity of EBP implementation, and assists with the adaptation of EBPs to specific client problems, populations, or settings ( 6– 10). Implementation frameworks and quality improvement initiatives emphasize the importance of supervision and feedback in advancing practitioners’ use of evidence-based practices (EBPs) in community mental health services ( 1– 5).
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