Commitment, involvement, and accountability of leaders and managers  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. Anything less than wholehearted support from leaders dooms implementation to failure . 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 .
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 . Leaders can be important conduits to help persuade stakeholders via interpersonal channels and by modeling norms (see Learning Climate) associated with implementing an intervention . 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) .
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.”
Exclude or double code statements regarding leadership engagement to Engaging: Formally Appointed Internal Implementation Leaders or Champions if an organizational 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.
- The Implementation Leadership Scale (ILS)
- Maria Fernandez and colleagues developed 4 items related to Leadership Engagement. Measures are available for review here. For permission to use, please contact Dr. Fernandez at: Maria.E.Fernandez at uth-dot-tmc-dot-edu
Note: As we become aware of measures, we will post them here. Please contact us with updates.
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- 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.
- 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.
- Meyer AD, Goes JB: Organisational Assimilation of Innovations: A Multi-Level Contextual Analysis. Acad Manage J 1988, 31:897-923.
- Repenning NP: A simulation-based approach to understanding the dynamics of innovation implementation. Organization Science 2002, 13:109-127.
- 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.
- Gershon R, Stone PW, Bakken S, Larson E: Measurement of Organizational Culture and Climate in Healthcare. J Nurs Adm 2004, 34:33-40