The updated CFIR (Damschroder, Reardon, Widerquist, et al. 2022) divides formal leadership roles into two levels: Mid-level Leaders and High-level Leaders (see Individuals: Roles: High-level Leaders).
Mid-level managers are a key link between strategic decisions from High-level Leaders and the people who must execute implementation and accomplish delivery of the innovation (S. A. Birken and Currie 2021; S. Birken et al. 2018). Mid-level Leaders can include clinical leaders who often lead implementation efforts (Ilott et al. 2012) and/or direct supervisors of Implementation Leads and others involved in implementation. Mid-level Leaders are benefited by having skills in mediating between high-level strategy in the Inner Setting and day-to-day activities and in diffusing, selling, and synthesizing information related to the innovation and its implementation (see Individuals: Characteristics: Capability) (S. Birken et al. 2018). These leaders are more likely to support implementation if they believe that doing so will promote their own Inner Setting goals (see Inner Setting: Mission Alignment) and if they feel involved in discussions about the implementation (P. W. Meyers et al. 1999).
Commitment of individuals (see Individuals: 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 Individuals: Characteristics: Motivation and Opportunity) of leaders and managers have a significant influence on the success of implementation (Klein et al. 2001; P. W. Meyers et al. 1999; VanDeusen Lukas et al. 2007). Leadership support in terms of commitment and active interest leads to a stronger implementation climate which is related to implementation effectiveness; this association is strengthened with more users being required to work together to implement (Helfrich, Weiner, et al. 2007; Klein et al. 2001). Committed leaders have managerial patience (taking a long- vs. short-term view) to allow time for reduction in productivity until full adoption of the innovation (Klein et al. 2001). Leaders can be important conduits to help persuade other individuals via interpersonal channels and by modeling norms (see Inner Setting Culture: Learning-Centeredness) associated with implementing an innovation (Leeman et al. 2007). Leaders are important for their ability to network (see Inner Setting: Relational Connections), negotiate for resources (see Inner Setting: Available Resources), allocate time (see Individuals: Characteristics: Opportunity), and demonstrate priority (see Inner Setting: Relative Priority).