Suvi Kuha, Jouko Miettunen, Outi Kanste
A total of 22 studies published between 2014 and 2025 across nine countries, involving 9970 participants, were included. The overall pooled mean level of implementation leadership in EBP, measured using the Implementation Leadership Scale (range 0-4), was 2.66 (95% CI: 2.49-2.83). Subscale pooled means were highest for supportive leadership (3.00, 95% CI: 2.83-3.16), followed by knowledgeable (2.78, 95% CI: 2.57-3.00), perseverant (2.77, 95% CI: 2.58-2.96), and proactive leadership (2.43, 95% CI: 2.25-2.61). Subgroup analyses showed pooled means of 2.47 (95% CI: 1.98-2.97) for managers and 2.70 (95% CI: 2.52-2.88) for professionals. Considerable heterogeneity was observed across studies.
BACKGROUND: Evidence-based practice (EBP) is essential in contemporary high-pressure healthcare environments, yet its implementation remains challenging. Despite the pivotal role of leadership, the lack of pooled quantitative evidence limits understanding of implementation leadership levels and the identification of development needs.
AIM: To investigate the pooled mean levels of implementation leadership in EBP among healthcare professionals and managers.
DESIGN: Systematic review and meta-analysis.
METHODS: This systematic review followed the Joanna Briggs Institute methodology and utilized the PRISMA statement. Findings were synthesized using random-effects meta-analyses of mean levels. Heterogeneity was assessed using the I2 statistic. A systematic search was conducted in November 2025 in MEDLINE (Ovid), CINAHL, Scopus, Web of Science, ProQuest, and Medic with no date or geographical limits. Studies in English, Finnish, and Swedish were included.
RESULTS: A total of 22 studies published between 2014 and 2025 across nine countries, involving 9970 participants, were included. The overall pooled mean level of implementation leadership in EBP, measured using the Implementation Leadership Scale (range 0-4), was 2.66 (95% CI: 2.49-2.83). Subscale pooled means were highest for supportive leadership (3.00, 95% CI: 2.83-3.16), followed by knowledgeable (2.78, 95% CI: 2.57-3.00), perseverant (2.77, 95% CI: 2.58-2.96), and proactive leadership (2.43, 95% CI: 2.25-2.61). Subgroup analyses showed pooled means of 2.47 (95% CI: 1.98-2.97) for managers and 2.70 (95% CI: 2.52-2.88) for professionals. Considerable heterogeneity was observed across studies.
LINKING EVIDENCE TO ACTION: Strengthening implementation leadership to support EBP is needed across healthcare. Organizations should invest in structured, targeted leadership development initiatives that cultivate supportive, knowledgeable, perseverant, and especially proactive leadership behaviors, while ensuring programmes are context-sensitive and adaptable to variability across healthcare settings. In addition, role-based differences highlight the need for tailored support for managers that reflect the complexity and accountability of their leadership responsibilities.
TRIAL REGISTRATION: PROSPERO ID: [CRD420251241584].