A mixed methods investigation of leadership and performance in practice-based research networks

The objectives of this study were to: 1) create a measure of PBRN clinician member individual performance; 2) produce a rich description of PBRN directors' leadership behaviors and styles; and, 3) identify significant relationships between PBRN director leadership-PBRN clinician member performance. A sequential, exploratory mixed methods design was used to interview and survey PBRN directors and non-director participants. In Phase I, a semi-structured interview guide was used to identify PBRN director leadership behaviors, PBRN non-director performance behaviors and expectations, and decision making activities. A clinician member performance measure was created using a validated behavioral item extraction method. A thematic analysis was conducted on all other data. In Phase II, two quantitative surveys were administered to PBRN directors assessing demographics, membership activity, PBRN productivity, and clinician member performance. One survey was administered to PBRN clinician members assessing their demographics, activity level, and their perceptions of PBRN leadership behaviors. Clinician member performance within PBRNs is a multidimensional construct distinct from participation that is comprised of ownership and engagement aspects, although there is some evidence of a further division into leadership, awareness, follow-through, and communication factors. Collaborative leadership was reported as being distributed to all roles in the PBRN, but is primarily inculcated by a collaborative PBRN director. Time and funding were reported as important resources necessary for the completion of PBRN activities, and are increasingly becoming more limited in their availability. PBRNs engage in a variety of projects and other activities carried out and monitored through ongoing collaborative communication and consensus-based decision making efforts. Top-down decision making patterns by PBRNs have negative relationships with measures of productivity. Directive and participative leadership behaviors do not appear to have direct relationship with clinician member performance, but years of involvement in current PBRN does have a positive association. However, further investigation is necessary to replicate these findings in larger samples. Aiding busy clinicians with engagement through use of central staff may be beneficial. PBRN directors should focus on strengthening collaborative culture of their PBRN and minimizing barriers to effective communication and decision making.