Transformational Leadership and Evidence-Based Practice in Nursing

Introduction: Transformational Leadership as Innovation

Transformational leadership may be defined as an innovation, as it is not yet in wide or general practice across medical and healthcare fields. By definition, an innovation must be characterized by benefits that accrue only through its adoption into practice or general use. Transformational leadership has been shown to benefit patients and patient care, as well as the nurses who practice it and the colleagues who are directly influenced by transformational leaders. Because of these benefits, it is anticipated that nurse attrition may be reduced through the diffusion of transformational leadership into clinical practice.

Diffusion of Innovation Theory as a Change Model

A variety of change models have been employed to describe the introduction and adoption of innovations in professional practice. The diffusion of innovation theory, a change model developed by Everett Rogers, is particularly well suited as a framework for introducing innovation into a clinical or hospital setting. Rogers posited that the diffusion of an innovation takes place across four distinct stages: the actual invention or introduction of an innovation; diffusion through communication across a social network or system; the passage of time; and the consequences or outcomes that follow introduction and/or adoption of the innovation. The step-wise proposed solution of introducing a leadership-oriented program for higher-level nurses directly addresses these stages of diffusion as the training plan is implemented.

At the core of the diffusion of innovation theory is the construct that certain conditions can increase or decrease the likelihood that an innovation will be adopted. The following influential conditions have been considered for the proposed solution: the roles of adopters in the social system; the attributes of the innovation itself; the modes of communication used in the social network; the complexity of the decisions to be made about the innovation; and the attributes of the social context.

Environmental Assessment and Communication Strategy

The transformational leadership training plan will be implemented through a series of steps as outlined below. Each step includes a discussion of how the change model applies to that particular stage and how outcomes are measured according to the tenets of the model.

An environmental scan or assessment will help identify sources of negativity that could undermine the change effort if they are not addressed or brought into the open. Eliminating all forms of negativity is not a realistic expectation; however, Rogers's diffusion of innovation theory points to certain attributes of the social context, the decision process, and communication styles that can be modified to condition the environment for change. Those seeking to introduce the innovation should target their communications — about the innovation itself, or about underlying problems that may act as barriers to diffusion — toward people who have a "professional resemblance" to them (Sanson-Fisher, 2004). As much as possible, communication should be face-to-face, as this allows messages about the innovation to be shaped to fit the audience's receptivity and to address persistent questions.

This first step in the training process corresponds with the first stage in the decision process: awareness of the innovation. The second stage in the decision process is when others are encouraged to consider the advantages and benefits of the innovation they are expected to adopt. Discussion of the second and third stages follows below.