Table 7 Illustration of Guide content: sample material for a sub-element

Leadership support

Leadership = Individuals in designated positions "...at any level of the organization including executive leaders, middle management, front-line supervisors, and team leaders, who have a direct or indirect influence on the implementation" [7]

Leadership Support = Behaviors, [verbalized] attitudes, and actions of leaders that reflect readiness or receptivity to a change [17]

• In general, relevant leaders' "supportive" actions can be characterized by various types of managerial behaviors or responsibilities, within a change/innovation situation such as EBP, as listed below. These are not directly taken from the original PARIHS framework but rather have been adapted based on the following: a task-oriented view of related PARIHS sub-elements, supplemental information from relevant papers [17][36, 37], relevant EBP behaviors of transformational leaders [17], and an effort to use language more familiar to targeted researchers.

• Role clarity, e.g., ensuring transparency regarding both project-related and relevant change-related role responsibilities and accountabilities.

• To what extent do leaders show active and visible support for this change or this type of EBP and implementation?

○ Is the leader willing to engage with the study team for planning?

○ Is the leader willing to provide connections/entrees for the study team?

○ Does the leader have experience/comfort in this role?

○ Does the leader hold service directors accountable for collaboration and coordination in such change efforts/in this effort?

• To what extent are appropriate stakeholders or teams held accountable and incentivized or rewarded to carry out the implementation?

○ What about past experiences with this type of change?

• To what extent does the leader indicate the willingness to and in fact does the leader communicate the priority of this implementation?