Implementation Leads

Implementation Leads may emerge organically out of a grassroots (bottom-up) initiative to e.g., improve use of an innovation (Bonawitz et al., 2020; Damschroder, Banaszak-Holl, et al., 2009). Alternatively, Implementation Leads may be identified through top-down assignment. Ilot et al. found that “none of the instigators” of implementation were formally appointed in their cross-case comparison study, though some ultimately assumed that role (Ilott et al., 2012). Individuals who volunteer to lead may be more effective than those who were assigned the role (Bonawitz et al., 2020).

The term Implementation Lead is used to focus on individuals who are leading the implementation effort. These individuals take on the role as coordinator, project manager, team leader, or other similar responsibility. These leaders may or may not have dedicated time allocation to the role (see Opportunity). The term champion may be used to describe the person leading implementation (Miech et al., 2018); it is important to distinguish the role of champion versus championing behavior that can be exhibited by many of the listed implementation roles (see Motivation). Implementation Leads benefit from having project management skills, including critical thinking, influence, motivation, grit, conscientiousness, negotiation, participatory leadership style, and problem-solving (see Characteristics) (Barron & Barron, n.d.-a; Bonawitz et al., 2020; Müller & Turner, 2010).

The original CFIR elaborated on this role further by noting that ideally, Implementation Leads dedicate themselves to supporting, marketing, and ‘driving through an [implementation]’ (Greenhalgh, Glenn Robert, et al., 2004), overcoming indifference or resistance that the innovation may provoke in an organization. Ideally, Implementation Leads bring a high degree of passion, creativity, and willingness to take risks in accomplishing implementation goals (see Characteristics) (Maidique, 1980). There is strong to moderate support for the role of Implementation Leads on implementation outcomes, (Greenhalgh, Robert, et al., 2004; Helfrich, Weiner, et al., 2007; Miech et al., 2018; E. Rogers, 2003) though a more recent review found mixed impacts (Santos et al., 2022).

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

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Dorsey et al. did not identify any measures (search terms included implementation leader, coordinator, project manager, or team leader), but they did identify five measures related to champions (search terms included champion, transformational leader, campaigner, promoter, proponent, or supporter) (Dorsey et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), scores for the three champion measures that could be assessed ranged from -1 to +5. 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.

Barron, M., & Barron, A. (n.d.-a). Project Management Areas of Expertise. In Project Management. sue. Retrieved March 23, 2022, from https://cnx.org/contents/XpF315mY@11.6:_nDfs3nk@2/Project-Management-Areas-of-Expertise.

Bonawitz, K., Wetmore, M., Heisler, M., Dalton, V. K., Damschroder, L. J., Forman, J., Allan, K. R., & Moniz, M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare? Implementation Science, 15(1), 62. https://doi.org/10.1186/s13012-020-01024-9.

Damschroder, L. J., Banaszak-Holl, J., Kowalski, C. P., Forman, J., Saint, S., & Krein, S. L. (2009). The role of the champion in infection prevention: Results from a multisite qualitative study. Quality & Safety in Health Care, 18(6), 434–440. https://doi.org/10.1136/qshc.2009.034199.

Dorsey, C. N., Mettert, K. D., Puspitasari, A. J., Damschroder, L. J., & Lewis, C. C. (2021). A systematic review of measures of implementation players and processes: Summarizing the dearth of psychometric evidence. Implementation Research and Practice, 2, 263348952110024. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q, 82(4), 581–629.

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.

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.

Maidique, M. A. (1980). Entrepeneurs, champions and technological innovation. Sloan Management Review, 21, 59–76.

Miech, E. J., Rattray, N. A., Flanagan, M. E., Damschroder, L., Schmid, A. A., & Damush, T. M. (2018). Inside help: An integrative review of champions in healthcare-related implementation. SAGE Open Medicine, 6, 205031211877326. https://doi.org/10.1177/2050312118773261.

Müller, R., & Turner, R. (2010). Leadership competency profiles of successful project managers. International Journal of Project Management, 28(5), 437–448. https://doi.org/10.1016/j.ijproman.2009.09.003.

Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.

Santos, W. J., Graham, I. D., Lalonde, M., Demery Varin, M., & Squires, J. E. (2022). The effectiveness of champions in implementing innovations in health care: A systematic review. Implementation Science Communications, 3(1), 80. https://doi.org/10.1186/s43058-022-00315-0.