Transformational Leadership in Evidence-Based Practice: An Integrative Review

Leaders are critical to implementing successful evidence-based practice in health care. Although there has been much research on leadership, research on explicit leader behaviors to support the implementation of evidence-based practice in health care has been limited.  To narrow the scope of leadership, research addressing transformational leadership in evidence-based practice was systematically reviewed to reveal implementation strategies in health care settings.   Electronic health care databases were searched with over 113 articles initially identified from 2000 to 2015 limited to the English language.  After screening the articles, 16 studies met the criteria for inclusion in an integrative review which included research focused on transformational leaders implementing evidence-based practice in clinical settings. The 16 studies found successful leadership strategies such as inspiring, mentoring and coaching, supporting innovation, securing resources, promoting staff development, and inclusive decision making which were common functions of leaders from most theoretical frameworks.  However, methodological issues clouded the studies from clinical practice.  One issue was clarifying the definition and roles of the leader and manager.  Another issue was the overlapping nature of transformational leadership functions with other leadership theoretical frameworks.   Leadership was broadly defined in practice and the literature so it was difficult to differentiate transformational leadership frameworks in practice from other leadership frameworks.   For nurse leaders and nurse researchers, specifying leadership behaviors that support evidence-based practice is paramount. With this specification, nurses should identify leadership strategies that sustain ongoing evidence-based practice. The 16 studies had limitations in research designs including a small number of control groups. Nurses in clinical practice need to strive to develop evidence-based research with rigorous research designs.   This integrative review synthesized research studies on transformational leadership in evidence –based practice in clinical settings.   A weakness of the integrative review is not creating a summary statistic because of the heterogeneous nature of the research articles which were both quantitative and qualitative. From this integrative review, nurses can identify successful leadership strategies for implementing and sustaining evidence-based practice guided by transformational leadership across studies.