Leadership Engagement

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Leadership Engagement
Inner Setting
Readiness for Implementation
Access to Knowledge & Information
Available Resources
Leadership Engagement
Measurement maturity
Quantitative tools
Implementation Leadership ScaleLink to article, instrument, and scoring instructions


Version 1.0

Commitment, involvement, and accountability of leaders and managers with the implementation.


Commitment, involvement, and accountability of leaders and managers[1][2] with the implementation. The term 'leadership' can refer to leaders 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. One important dimension of organizational commitment is managerial patience (taking a long-term view rather than short-term) to allow time for the often inevitable reduction in productivity until the intervention takes hold[1].

Rationale for inclusion

Commitment, involvement, and accountability of leaders and managers[1][2][3][4][5]. Commitment, involvement, and accountability of leaders and managers have a significant influence on the success of implementation[2][4]. Anything less than wholehearted support from leaders dooms implementation to failure[5]. Leadership support in terms of commitment and active interest leads to a stronger implementation climate which is, in turn, related to implementation effectiveness; this association is strengthened, the more users are required to work together to implement[1][3]. Leaders can be important conduits to help persuade stakeholders via interpersonal channels and by modeling norms (see Learning Climate) associated with implementing an intervention[6]. Managerial patience (taking a long-term view rather than short-term) allows time for the often inevitable reduction in productivity until the intervention takes hold which heightens the likelihood of successful implementation[1]. Middle managers, in addition to high-level leaders, are important for their ability to network (see Networks and Communication) and negotiate for resources (see Available Resources) and priority (see Relative Priority). Middle managers are more likely to support implementation if they believe that doing so will promote their own organizational goals (see Compatibility) and if they feel involved in discussions about the implementation (see Engaging)[7].


Qualitative codebook guidelines

Inclusion criteria

Include statements regarding the level of engagement of organizational leadership.

Note: There can be confusion at times between this construct and the Process: Engaging construct; some users have asked why leaders do not appear under Engaging. A note has been entered under DISCUSSION (click on the table above) to rename this construct to Leadership Commitment or Leadership Support to help avoid confusion resulting from multiple uses of the term "Engagement" under Inner Setting and Process. Here is an explanation:

Organizational leaders are an integral part of the organization; their role is not defined by the implementation project at hand. All the other roles listed under Engaging are roles that exist only because of the current change effort, e.g. Champions are not champions for everything, only for that change effort. Although some people may champion multiple change efforts, they cannot possibly champion everything; champion is not a stable organizational role. Organizational leaders delegate specific implementation efforts to other staff or teams, and then the question is, to what extent do they commit, endorse, and support their efforts?

Leader apathy can hinder implementation efforts and implementation leaders need to develop strategies to engage leadership by meeting with them, discussing their concerns, fostering alignment of the implementation with organizational plans and goals, brainstorming solutions to problems early in the process to cultivate their ownership in solutions, and persuading them to visibly notify stakeholders that they support the change. These are all techniques the implementation leader or team can consider in order to gain leadership support and overcome leader apathy.

  • "My supervisor comes to all the meetings.”
  • “My supervisor’s good; she’s been involved enough to show us that it’s important.”
  • “The hospital director asks about it in weekly reports.”
  • “I know if anything goes wrong, I can go to the chief of staff and she’ll take care of it.”
  • “It’s hard to get anything done around here because half the time, the director of the unit is out of town or has some kind of conflict.”
  • “The powers that be told me not to go to those meetings any more.”

Exclusion criteria

Exclude or double code statements regarding leadership engagement to Engaging: Formally Appointed Internal Implementation Leaders or Champions if an organizational leader is also an implementation leader, e.g., if a director of primary care takes the lead in implementing a new treatment guideline. Note that a key characteristic of this Implementation Leader/Champion is that s/he is also an Organizational Leader.

Quantitative measures

Implementation Leadership Scale

Source: Link to article, instrument, and scoring instructions


BACKGROUND: In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). METHODS: Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. RESULTS: The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. CONCLUSIONS: The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation.




  1. 1.0 1.1 1.2 1.3 1.4 Klein KJ, Conn AB, Sorra JS: Implementing computerized technology: An organizational analysis. J Appl Psychol 2001, 86:811-824.
  2. 2.0 2.1 2.2 VanDeusen Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP: Transformational change in health care systems: An organizational model. Health Care Manage Rev 2007, 32:309-320.
  3. 3.0 3.1 Helfrich CD, Weiner BJ, McKinney MM, Minasian L: Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev 2007, 64:279-303.
  4. 4.0 4.1 Meyer AD, Goes JB: Organisational Assimilation of Innovations: A Multi-Level Contextual Analysis. Acad Manage J 1988, 31:897-923.
  5. 5.0 5.1 Repenning NP: A simulation-based approach to understanding the dynamics of innovation implementation. Organization Science 2002, 13:109-127.
  6. Leeman J, Baernholdt M, Sandelowski M: Developing a theory-based taxonomy of methods for implementing change in practice. J Adv Nurs 2007, 58:191-200.
  7. Gershon R, Stone PW, Bakken S, Larson E: Measurement of Organizational Culture and Climate in Healthcare. J Nurs Adm 2004, 34:33-40.
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