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Randomized Controlled Trial
. 2022 Aug 20;22(1):1065.
doi: 10.1186/s12913-022-08434-z.

How is leadership behavior associated with organization-related variables? Translation and psychometric evaluation of the implementation leadership scale in German primary healthcare

Sara Söling  1   2 , Holger Pfaff  3 , Ute Karbach  4 , Lena Ansmann  5 , Juliane Köberlein-Neu  6 ; AdAM-Study Group
Collaborators, Affiliations
Randomized Controlled Trial

How is leadership behavior associated with organization-related variables? Translation and psychometric evaluation of the implementation leadership scale in German primary healthcare

Sara Söling et al. BMC Health Serv Res. .

Abstract

Background: The Implementation Leadership Scale (ILS) was developed to assess leadership behavior with regard to being proactive, knowledgeable, supportive, or perseverant in implementing evidence-based practices (EBPs). As part of a study on the implementation of a digitally supported polypharmacy management application in primary care, the original ILS was translated and validated for use in the German language.

Rationale: This study aimed to translate the original ILS into German and evaluate its psychometric properties.

Methods: The validation sample consisted of 198 primary care physicians in a cluster-randomized controlled trial in which the intervention group implemented a digitally supported clinical decision support system for polypharmacy management. The ILS was assessed using a 12-item scale. The study included a process evaluation with two evaluation waves between 2019 and 2021. The ILS was used within this process evaluation study to assess the leadership support with regard to the implementation of the polypharmacy management. The ILS was translated in a multi-step process, including pre-testing of the instrument and triple, back-and-forth translation of the instrument. We tested the reliability (Cronbach's alpha) and validity (construct and criterion-related validity) of the scale.

Results: The four-dimensional structure of the instrument was confirmed (comparative fit index = .97; root mean square error of approximation = .06). Convergent validity was demonstrated by correlations with organizational innovation climate, social capital, and workload, which was consistent with the proposed hypothesis. Criterion-related validity of the ILS was demonstrated by predicting the organizational readiness for change scores using structural equation modeling. The reliability of the scale was good (α = .875).

Conclusion: The German version of the ILS created in this study is a reliable and valid measure. The original four-dimensional structure of the ILS was confirmed in a primary care setting. Further psychometric testing is needed to establish the validity and reliability of the ILS and to transfer it to other health care settings. It is a useful tool for identifying the areas for implementation leadership development. Further research is needed on how, why, and when distinct types of leadership behaviors have different effects on healthcare organizations in implementation processes.

Keywords: Change management; Digital technology; Innovation climate; Leadership; Medication therapy management; Organizational culture; Social Capital.

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Conflict of interest statement

Prof. Holger Pfaff is a member of the editorial board of BMC Health Services Research. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual Model. Notes: The subject matter of the present study = all measures colored in gray; determinants and outcomes of organizational readiness approach = all constructs in frames with solid lines; inner setting domain of CFIR (related constructs) = frame with dotted lines
Fig. 2
Fig. 2
Factor loadings for the implementation leadership scale. Note: n = 198; all factor loadings are standardized and statistically significant, p < .001; χ2(48) = 84.59, p < .001; comparative fit index = .974; Tucker-Lewis index = .965; root mean square error of approximation = .062; standardized root mean quare residual = .051
See this image and copyright information in PMC

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