High-Level Leaders

Individuals with a high level of authority, including key decision-makers, executive leaders, or directors.

The updated CFIR divides formal leadership roles into two levels (see below). Commitment of individuals (see also Characteristics: Motivation) in formal leadership roles at multiple levels is a significant and frequently assessed determinant of implementation outcomes (Kirk et al., 2015). Commitment, involvement, and accountability (see also Characteristics: Motivation and Opportunity) of leaders and managers have a significant influence on the success of implementation (Klein et al., 2001; Meyers et al., 1999; VanDeusen Lukas et al., 2007). Anything less than wholehearted support from leaders, dooms implementation to failure (Repenning, 2002). 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 (Helfrich, Weiner, et al., 2007; Klein et al., 2001). Committed leaders have managerial patience (taking a long-term view rather than short-term) to allow time for the oft-inevitable reduction in productivity until the innovation takes hold (Klein et al., 2001) and can be important conduits to help persuade other individuals via interpersonal channels and by modeling norms (see Culture: Learning-Centeredness) associated with implementing an innovation (Leeman et al., 2007). Leaders are important for their ability to network (see also Relational Connections) and negotiate for resources (see also Available Resources), allocating time (see also Characteristics: Opportunity) and priority (see also Relative Priority).

High-level Leaders include leaders with the authority to dedicate resources and to make decisions about whether to adopt, implement, and or/sustain the innovation (see Opportunity) (Dy et al., 2015).

The involvement of leaders and managers (Klein et al., 2001; Moretto et al., 2019; VanDeusen Lukas et al., 2007) is often critical to implementation success (see Motivation). Different levels of leadership may have differential effects on implementation success, thus the updated CFIR distinguishes between levels of leadership (see Mid-level Leaders below) (Ilott et al., 2012).

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.

Regarding quantitative measurement of High-level Leaders (see also Characteristics: Motivation): In a systematic review of quantitative measures related to the 2009 CFIR’s Leadership Engagement role in implementation, Weiner et al. identified 24 measures (Weiner et al., 2020). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), 17 measures (70.83%) had sufficient information for assessment and scores ranged from -1 to +14. The Implementation Leadership Scale (Aarons et al., 2014) had the highest score of 14. Results indicate the need for continued development of high-quality measures.

As we become aware of measures, we will post them here. Please contact us with updates.

Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadership scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science, 9(1), 45. https://doi.org/10.1186/1748-5908-9-45.

Dy, S. M., Ashok, M., Wines, R. C., & Rojas Smith, L. (2015). A Framework to Guide Implementation Research for Care Transitions Interventions: Journal for Healthcare Quality, 37(1), 41–54. https://doi.org/10.1097/01.JHQ.0000460121.06309.f9.

Helfrich, C. D., Weiner, B. J., McKinney, M. M., & Minasian, L. (2007). Determinants of implementation effectiveness: Adapting a framework for complex innovations. Med Care Res Rev, 64(3), 279–303.

Ilott, I., Gerrish, K., Booth, A., & Field, B. (2012). Testing the Consolidated Framework for Implementation Research on health care innovations from South Yorkshire: Testing the CFIR on health care innovations. Journal of Evaluation in Clinical Practice, n/a-n/a. https://doi.org/10.1111/j.1365-2753.2012.01876.x.

Kirk, M. A., Kelley, C., Yankey, N., Birken, S. A., Abadie, B., & Damschroder, L. (2015). A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation Science, 11(1), 72. https://doi.org/10.1186/s13012-016-0437-z.

Klein, K. J., Conn, A. B., & Sorra, J. S. (2001). Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5), 811–824.

Leeman, J., Baernholdt, M., & Sandelowski, M. (2007). Developing a theory-based taxonomy of methods for implementing change in practice. J Adv Nurs, 58(2), 191–200.

Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373. https://doi.org/10.1177/26334895211037391.

Meyers, P. W., Sivakumar, K., & Nakata, C. (1999). Implementation of Industrial Process Innovations: Factors, Effects, and Marketing Implications. Journal of Product Innovation Management, 16(3), 295–311. https://doi.org/10.1111/1540-5885.1630295.

Moretto, N., Comans, T. A., Chang, A. T., O’Leary, S. P., Osborne, S., Carter, H. E., Smith, D., Cavanagh, T., Blond, D., & Raymer, M. (2019). Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services. Implementation Science, 14(1), 78. https://doi.org/10.1186/s13012-019-0923-1.

Repenning, N. P. (2002). A Simulation-Based Approach to Understanding the Dynamics of Innovation Implementation. Organization Science, 13(2), 109–127. https://doi.org/10.1287/orsc.

VanDeusen Lukas, C., Holmes, S. K., Cohen, A. B., Restuccia, J., Cramer, I. E., Shwartz, M., & Charns, M. P. (2007). Transformational change in health care systems: An organizational model. Health Care Management Review, 32(4), 309–320. https://doi.org/10.1097/01.HMR.0000296785.29718.5d.

Weiner, B. J., Mettert, K. D., Dorsey, C. N., Nolen, E. A., Stanick, C., Powell, B. J., & Lewis, C. C. (2020). Measuring readiness for implementation: A systematic review of measures’ psychometric and pragmatic properties. Implementation Research and Practice, 1, 263348952093389. https://doi.org/10.1177/2633489520933896.