Implementation Science Strategies: Using Opinion Leaders

When we need to implement improvements in care, or simply bring daily practice into alignment with best-evidence care, implementation science (IS) provides us with conceptual models of how to bring about change and strategies to promote the uptake of evidence-based practice. Among the strategies recommended to help get evidence into routine practice is the use of opinion leaders to endorse and educate peers about the desired practice.??

Opinion leaders are well-regarded by others in the work area, usually for their expertise or unique knowledge, but also because of their accessibility and willingness to share information and problem-solve with their colleagues. They may also have seniority, prestige due to either authority or reputation, and/or personal qualities, such as perceived calm demeanor or wisdom. Conceivably, an opinion leader can come from any hierarchical level of a workplace. The defining characteristic is that others seek out or heed their opinions, and that they wield some level of informal influence over the opinions of others.

In a recent review of the effectiveness of using opinion leaders to implement evidence-based practice, Flodgren and colleagues (2019) found that using opinion leaders generally promoted the use of evidence.?The studies reviewed considered various topics and included different comparisons—that is, sometimes opinion leaders were stand-alone, sometimes they were included with other interventions; also some were compared to no intervention, other times they were compared to an intervention package.?Considering eighteen studies that included about three hundred hospitals and three hundred primary care providers, the effect of opinion leaders was a 12% absolute increase in compliance (1).?

For an agent of change (perhaps yourself!), an opinion leader offers a channel through which to send messages about implementing evidence-based practices. As an example, if everyone respects “Jean,” getting Jean on board with the use of non-slip socks may be a shortcut to raising awareness and changing others’ minds.?If Jean can show a few people how to address patient resistance to putting on the socks, it may go a long way toward improving compliance, and is very likely more reliable than posting another memo in the break room.?

How would a change agent go about identifying opinion leaders? ?

Although it might be natural to just approach the individual that you personally assess as an opinion leader, that method could be subject to bias if others view their colleagues differently than you do.?Having opinion-leaders self-identify also has problems. Most studies use empirical data about who is contacted most frequently by others for advice.?This information can be difficult to collect; so, change agents may want to base their selection of opinion leaders on observations. You can do this by observing who you see answering questions for others most often, or you can ask a range of different people who they go to most frequently when they need advice about delivering care. Once it is clear who the opinion leaders are, the change agent can directly approach the opinion leader for assistance in sharing information and role modeling the desired change. ?

Make a difference in your workplace by implementing evidence-based practice today!

References

1.??????????Flodgren G, O'Brien MA, Parmelli E, Grimshaw JM. Local opinion leaders: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2019 Jun 24;6:CD000125

__________________________________________________________________________

?About the Author:?Jill Marsteller, Ph.D. is a Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.?She is jointly appointed in the Johns Hopkins School of Medicine's Department of Anesthesia and Critical Care Medicine in the Armstrong Institute for Patient Safety and Quality, where she leads the Research Facilitation Council, and at the Johns Hopkins Carey Business School.?Jill specializes in organizational behavior and theory and focuses her research on the determinants of successful implementation, dissemination, and sustainability of knowledge. She conducts mixed methods research in both inpatient and ambulatory health care settings.