Core leadership structures

Index

As a social movement in the context of evidence uptake and sustainability establishes and evolves, a core leadership structure is needed to guide the change initiative and provide strategic direction. A core leadership structure may have many names such as a change team, a steering committee, or an implementation team.

In this section, you will learn the diverse skill set required for members of the core leadership structure to be able to work together as a team and also engage colleagues and others in the change initiative.    

core

What is this element?

A core leadership structure includes formal and informal leaders who work internally (as an inward-facing team) and as an outward-facing team to guide the evolution of a social movement. Leadership is not vested in one person, but across a group of people.

Whether the individuals in the core leadership structure are the initial supporters of the shared concern or desired change –initiators or early adopters – or engage in the change later, all must bring a high level of commitment and energy (Bibby et al., 2009; Blueprints for Change, undated; del Castillo et al., 2016).   
Activities include:

  • planning and visioning
  • building a base of supporters to achieve a critical mass
  • defining priority areas and values
  • positioning issues
  • strategizing for mobilized individual and collective action
  • coordinating resources
  • supporting the development of a collective identity
  • building momentum
  • sustaining the cause (Bate et al., 2004a; Bibby et al., 2009; Blueprints for Change, undated; del Castillo et al., 2016). 

Working as an outward-facing team is also critical to engage staff’s active involvement and investment in the change. The core leadership team cannot ”own” the initiative, but must be flexible, responsive and open to the input and energy of others to gain momentum and evolve into a critical mass of supporters (Blueprint for Change, undated).    

Core leadership structures

Shared or distributed leadership

Leadership is described as shared, distributed, or horizontal with no team member holding more power and control than others.

The leadership structure is not hierarchical and does not apply a top-down “command and control” approach.

Each team member has roles and responsibilities and is accountable to their team members.

Decision-making is shared and equitable amongst the team members.
In cases where the core team determines their structures, roles and responsibilities, they may be self-governed and autonomous.

A mix of content and context experts

Content experts are those who understand change processes and the implementation of evidence uptake and sustainability. They can also be those with subject matter expertise in a clinical and/or work environment area.

Context experts are those who understand the local context – the dynamics and the meaning of the shared concern or strongly desired change in the given setting. They have lived experience of the shared concern and strongly support it as credible and valued.

Some people on the change team might be both content experts and context experts.

To create committed ownership, both types of experts must value one another’s knowledge and contributions to the team.

Organizational support

An effective core leadership structure is to be flexible. It engages the support of others, including formal leaders and peer champions.

Formal leaders – for example, managers or directors of care – can be instrumental in moving a change forward For example, they are needed to approve budgets, and might also be needed to approve collective action activities).

Peer champions (or change agents) are influential leaders who advance and translate the messages and goals of the core structure to their peers.

Variable roles and functions

Core leadership structures are variable and can include change teams, community coalitions, or social movement organizations (SMOs).

A core leadership structure typically has members from one setting and includes both informal and formal leaders whose roles are focused on guiding evidence-informed practice change.

Community coalitions include a group of diverse individuals who represent community services, such as health care, education, or policy. Their combined efforts are targeted at mobilizing for change.  

SMOs function in cases of larger social movements where there are regional chapters or groups and a need for a centralized organization to support and guide the broad goals of the social movement.

SOURCES: Bibby et al., 2009; Blueprints for Change, undated; Carson-Stevens et al., 2013; del Castillo et al., 2016; Dementia Action Alliance, 2009; Grinspun and Bajnok, 2018; Klaus & Saunders, 2016.   

“If a movement is to have impact it must belong to those who join it, not just those who lead it.”  (Simon Sinek, 2017)

Why is this element important?

Social movements require energy, planning and strategy. A core leadership structure is central to the social movement’s formation, advancement and maintenance. It ensures the coordination and organization of activities, the availability of time and resources, and the knowledge and experience in social movement thinking and actions (Bate et al., 2004a; Serna-Restrepo et al., 2018).

A key role of the core leadership structure is to build and support a group of individuals who share its leadership. Without leadership, the social movement will not continue. The team must also continue to invest and train new leaders to make sure that the leadership is replenished and maintained (Carson-Stevens et al., 2013; Grinspun et al., 2018b; Tremblay et al., 2018).

Case studies

BPSO
Guiding best practice guidelines (BPG) implementation with BPSO implementation teams

To support the effective implementation of BPGs, Best Practice Spotlight Organizations® (BPSOs®) create change teams that operate as core leadership structures to support evidence uptake and sustainability. Their roles in the core leadership structure can include:

  • selecting recommendations
  • developing an action plan
  • mobilizing implementation strategies
  • supporting adherence to a practice change
  • engaging in monitoring and evaluation activities
  • taking active steps to support sustainability

As champions, one role of BPSOs is to compare their current practice to the guideline recommendations to see how the current practice can be maintained, strengthened or changed. Taking a “can do” attitude, they actively collaborate with their peers throughout the change process, and value and welcome their input and ideas. They take on leadership roles to support evidence-based practice change in collaboration with nurses, other staff and others (Bajnok et al., 2018a). 

Global
Case Study
Engaging an interprofessional change team to lead implementation: West Park Healthcare Centre

West Park Healthcare Centre, an RNAO BPSO, is a rehabilitation and complex care centre in Toronto, Canada. They applied a compelling call to action to implement these RNAO BPGs: Assessment and Management of Pain, Client Centred Care and Prevention of Falls and Fall Injuries in the Older Adult. 

With support from senior leadership, interprofessional change teams – including nurse leaders, such as advanced practice nurses and nurse practitioners – were responsible for leading the implementation strategies, which included taking collective action. Implementation efforts focused on engaging in quality improvement measures, promoting the culture and values of evidence-based practice and aligning their implementation efforts to the organization’s culture and values. 

As members of the implementation teams, the nurse leaders were influencers who aimed to build collaborative and committed relationships amongst the interprofessional team and create a work environment that empowered staff to take evidence-based action. The team embraced diverse perspectives and knowledge to allow for adaptations to the local context.     

West Park Healthcare Center
CWSDS
Engaging collective strength in action at Central West Specialized Developmental Services

Central West Specialized Developmental Services (CWSDS) is a pre-designate Best Practice Spotlight Organization® (BPSO®.) During the BPSO pre-designation process, the CWSDS change team has built a strong core leadership structure to support the implementation of best practices, by including both formal and informal leaders.

The CWSDS change team relied on the following strategies to build a strong core leadership structure:

CWSDS’s RNAO-BPSO organizational structure. Figure provided with permission by CWSDS.

  • embedding the RNAO BPSO pre-designation process within the organization’s strategic plan.
  • emphasizing the interprofessional nature of the initiative by encouraging professionals from all disciplines to become involved.
  • engaging an interprofessional team of stakeholders within the organization with the change, including direct support professionals, managers, food services, human resources staff, and members of the communication and information technology teams.
  • encouraging stakeholders to become trained RNAO Best Practice Champions and to participate in RNAO events.
  • making sure all stakeholders were informed and involved in the change initiative (by, for example, providing updates during managerial meetings and including stakeholders in completing gap analyses.)
  • supporting Best Practice Champions in leading best practice guideline (BPG) implementation alongside the BPSO Steering Committee.

As a result of the change team’s work to build a core leadership structure, they were able to tailor the implementation of BPGs toward daily clinical problems relevant to their direct support professionals. This increased recognition of and support for their change initiative.

To learn more about CWSDS’s BPG implementation journey, watch their 38-minute webinar: Collective Strength in Action: How to Promote and Implement Best Practice Guidelines. 

Central West Specialized Developmental Services

Considerations for getting started

We outline core leadership strategies to reflect the structure’s functions as both an inward- and outward-facing team.

  1. building the core leadership structure,
  2. sharing leadership effectively,
  3. learning to work together,
  4. engaging staff and others in the change initiative, and
  5. managing risk and building trust.

Building the core leadership structure

A core leadership structure requires a group of people with a broad range of knowledge and skills: 

  • People with direct experience of the shared concern or strongly desired change, and/or their allies. This could include point-of-care staff as clinical content experts.
  • People in formal organizational roles such as directors of care or project managers.  
  • Independent thinkers with unique perspectives.
  • “Key influencers” – or, highly connected individual to staff and others, as determined by their peers.
  • Role models or advocates of evidence uptake and sustainability.
  • Highly trusted and credible individuals.
  • Strategic thinkers with skills in specific areas such as framing to position issues and promoting the collective narrative of the social movement.
  • People whose approach to change embodies the values of inclusivity and democracy.

Sharing leadership effectively

Below are some tips to help with building effective shared leadership in our change work.  

  • Understand the benefits of a shared leadership model as well as the challenges, such as additional time demands, “growing pains” of a learning curve of the leadership model, and how the model functions.
  • Work with an understanding that some core team members who are not familiar with a shared leadership model may initially struggle. Be alert to  any tensions that could develop regarding team dynamics, roles and responsibilities.
  • Engage individuals’ knowledge and decision-making skills to create equitable partnerships and trusting relationships.  
  • Seek a balance of power, mutual respect, trust and transparency amongst the team. Appreciate that pooling strengths, capacities and resources will lead to synergies that strengthens the team.
  • Promote collective agency – engage the shared knowledge and skills to effect change and the courage to lead it. 
  • Establish some degree of power and autonomy to make decisions in areas such as recruitment strategies, framing, deploying resources or planning individual and collective action.

Learning to work together

  • Establish a means of communication within the team to share ideas and updates (for example, a group email list or Facebook page).
  • Document roles, responsibilities and a code of conduct to support team functioning and manage expectations.
  • Allocate some time in meetings to support the core structure team as a living community, including activities aimed at building relationships, morale and cohesion within the group.
  • Develop key messages regarding the shared purpose or desired change and the core values to build alignment amongst core structure team members.
  • Be flexible regarding the structure, role and function of the team.

Engaging staff and others in the change initiative

  • Share the key messaging of the shared concern or desired change and the underlying values publicly with staff and others through communication channels.
  • Emphasize group members’ central roles and the need for active engagement as crucial to achieving goals.
  • Forge new relationships to support the recruitment of staff and others to build a critical mass.
  • Welcome group members’ ideas and be willing and able to pivot and reconsider priorities and actions.
  • Establish a means of communicating so that others can reach members of the core structure team and have opportunities for dialogue and discussion. 
    • For example, a shared hashtag can act as a forum to share ideas, raise awareness and build a collective identity. 

Managing risk and building trust

With any change process, perceived risks can arise that need to be managed by core leadership structures. This can be especially true in a context where social movement action approaches have not been used before, which could lead to some uncertainty or concern.

Building trust is essential to risk management. It’s important to focus on the three key factors that drive trust: 

  1. logic – having sound reasoning and judgment
  2. authenticity –being genuine and trustworthy
  3. empathy – caring for others

Trust developed in organizations and within change teams can be complex, fragile and easily shaken because of: 

  • multiple and sometimes conflicting messages and goals from staff
  • interactions between and among inter- and intra-professional groups

Here are some strategies you can use to manage risk and build trust in change teams.

  • Acknowledge any previous failed and successful attempts at change, lessons learned, and how these experiences can be used to inform the current change initiative.
  • Discuss the risks anticipated in making the change, how these will be managed, and the implications if the change fails.
  • Develop the respectful working relationships and the competencies needed for the change.
  • Take active steps to avoid eroding trust.

Watch for causes of trust breakdown, including:

  • inconsistent messaging (for example, not “walking the talk” or failing to follow through on priorities).
  • Inconsistent standards (for example, bending rules or favouritism).
  • Ignoring or tolerating problematic individuals rather than addressing any concerns regarding competence or negative attitudes openly and constructively.
  • Offering false or dishonest feedback to save face.
  • Micromanaging due to a lack of trust in others. 
  • Ignoring the “elephant in the room.”

SOURCES: Bate et al., 2004a; Blueprints for Change, undated; Carson-Stevens et al., 2013; del Castillo et al., 2016; Galford & Drapeau, 2003; Grinspun & Bajnok, 2018; Klaus & Saunders, 2016; Sustainable Improvement Team & the Horizons Team, 2018; Wynn et al., 2011. 

Accelerate Your Success: The Knowledge-to-Action Framework’s “Identify the problem” action cycle phase includes strategies for how change teams, as core leadership structures, can work together effectively. As change processes can be complex requiring  diverse knowledge and skills, members of change teams must become efficient at working together to be able to reach their goals. 

Navigating common problems

Here are some common problems you and your core leadership structure may experience and some suggested strategies to address the problems:

Common problem

There is a need to replace members of the core leadership structure.

Strategies to address the problem
  • Strive to find individuals who deeply support the shared concern or strongly desired change  
  • Be mindful of the diverse skill set needed to lead change and seek out individuals with those abilities
  • Recognize that significant time and commitment must be invested to build an effective core leadership structure
  • Continue to recruit and mentor new members of the team periodically.
     
Common problem

One or more individuals seek to dominate leadership, expecting others to comply with their ideas.

Strategies to address the problem
  • Remind the group that the strength of the core leadership structure is in its shared leadership model that includes decision-making.
  • Should one person continue to dominate, consider using democratic voting processes such as dot voting (see Framing through storytelling | RNAO.ca for more details and resources).   
  • Seek agreement at meetings regarding agenda items and priority areas.
  • Apply processes such as roundtable discussions to facilitate meaningful dialogue and decision-making.
Common problem

A member of the core leadership structure does not attend team meetings regularly.

Strategies to address the problem
  • Strive to establish meeting times that work for all members’ calendars, and reinforce the importance of all team members’ presence at meetings.
  • Establish a culture of accountability within the team, including clear expectations about following up and reporting back on agenda items. 
  • Repeat and reinforce positive examples of the team’s strength and effectiveness through  collaboration. 
  • Determine whether all of the team members remain committed to the shared concern or whether they have the available time needed to engage in the core leadership structure. Be aware that interest in participating in the core leadership structure may also change as the social movement evolves and priorities shift. 
  • Agree as a team on how many meetings a member can miss before being asked to leave the core leadership structure.
Common problem

The change team has not been able to actively engage others outside of the core leadership structure to co-design the change

Strategies to address the problem
  • Remain vigilant to engage others in relevant aspects of the change initiative, including individual and collective action activities.
  • Ensure regular updates from the core leadership team at staff meetings or huddles, and via communication forums such as group emails.
  • Be aware of the limited power of the core leadership structure to achieve and sustain change without the active engagement of others.  
Common problem

Micromanaging has put limits on the role and energy of those not in the core leadership structure.

Strategies to address the problem
  • Remain flexible and committed to making changes, as needed, to plans and actions based on feedback from others.
  • Be aware of and embrace the collective power and energy of others as a vital force for change. 
  • Avoid at all costs alienating others and ignoring their ideas, energy and feedback. 
  • Recognize that placing limits on engagement in change by those outside of the core leadership structure can lead to a social movement in name only that will likely fail.  

SOURCES: Blueprints for Change, undated; Dementia Action Alliance, 2009.

Check your progress

  • You have sought and found opportunities for team members to grow and develop their abilities as leaders.
  • You have developed capacity in framing, and are able to position the issues in ways that resonate with people’s emotions and values.
  • You have learned to think strategically and creatively in your approaches to change.
  • You have supported the development of others as leaders to sustain the social movement and core leadership team.
  • You have inspired others to get involved and commit to the change.
  • You have organized and brought together the needed resources. 
  • You have achieved goals fully or partially. 

SOURCES: Bibby et al., 2009; Blueprints for Change, undated; del Castillo et al., 2016; Ganz, 2018; Grinspun & Bajnok, 2018; Serna-Restrepo et al., 2018; Klaus & Saunders, 2016.

Accelerate Your Success: The Knowledge-to-Action Framework’s “Sustain Knowledge Use” action cycle phase includes strategies for change teams – as core leadership structures – to support the sustainability of a practice change. 

Achieving sustainability requires planning by change teams. Failure to sustain change can limit the positive impacts of the practice change to people or patients and their families, providers, organizations and/or health system. 

Determining your progress and impact 

Core leadership structures may want to determine their progress and impact as a team. While there are no formalized performance indicators in social movements, the following quantitative and qualitative measures may be helpful:

Quantitative measures

  • The number of staff who engaged in the change.
  • The number of staff who joined the core team, if applicable.
  • The number of communications released to staff.
  • The number of staff emails responded to by core team members.

Qualitative measures

  • The achievements of the change initiative.  
  • The impact of the change on the shared concern or strongly desired change.
  • The development of capacity in social movement thinking.
  • The effectiveness of using social movement thinking as a people-led approach to change. 

SOURCE: Blueprints for Change, undated.

Implementation tools

 For strategies on how to select a lead and co-lead for a core leadership,  download our resource sheet.

Linking this key characteristic to other framework components

linking banner

Linking this key characteristic to other elements of the Social Movement Action Framework:

Each of the elements of the Social Movement Action (SMA) Framework is dynamic and interrelated. For example, the core leadership structure brings together a group of committed team members to co-design the social movement with the active engagement of change agents, champions and others. The core team, as individuals and collectively, widely promotes and disseminates the shared concern or strongly desired change and the urgent need for action. Their roles include: 

  • framing or positioning the issue
  • relationship building
  • engaging others through intrinsic motivation
  • supporting emerging leaders actively. 

Linking this key characteristic to the action cycle phases of the Knowledge-to-Action Framework:

You and your core leadership structure’s capacity in social movement actions may be enhanced or accelerated by the addition of some of the action cycle phases of the Knowledge-to-Action (KTA) Framework, as the two frameworks are complementary. In addition to the two linking examples described earlier in this section, there can be many other points of connection between the two frameworks. Below are two more examples for your consideration:   

  • Adapt knowledge to local context: Core leadership structures function in part as ways of securing and deploying resources. Assessing the local context, individuals and/or groups can help you make sure that you and your change team have sufficient resources to execute your plans for the social movement.
  • Sustain knowledge use: To sustain change, leaders must commit to building networks and capacity in new leaders. The KTA action cycle phase on sustaining knowledge use can help you and your change team continue the core leadership structures of your social movement and give you guidance on how to enhance emerging leaders.

For more discussion about the dynamic links between the elements of the SMA Framework to one another and to the KTA Framework, see the section "Two complementary frameworks".

More resources

More Social Movement Action (SMA) Framework elements

The 16 elements of the Social Movement Action Framework are dynamic and inter-related. To learn more about two other elements, click the links below.