RESEARCH NEWS STORY
December 7, 2023
Chiba University
Keio University

Testing Implementation Leadership Scale for
Quality Care Delivery in Japan
Researchers validate the Japanese version of the ‘implementation leadership scale’ that canbe used to promote evidence-based practice in Japan
In Japan, there is a growing interest in implementing evidence-based practice (EBP) toensure the best possible care delivery. However, progress is slow and the implementation
lags behind in the field of nursing. To accelerate the implementation of EBP, researchers
have now developed a Japanese version of the implementation leadership scale to assessnursing managers’ strategic leadership in implementing EBP and effectively integrate
research evidence into clinical practice.

Image title: Path diagram of the Japanese version of the Implementation Leadership Scale(ILS).
Image caption: Researchers from Japan show how evidence-based practice (EBP) requires
identifying the readiness and processes necessary to institute EBP. Derived from the original
ILS developed by Aarons et al.*, this version was developed to promote EBP in Japan and toenable international comparisons of leadership in clinical practice.

*Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadershipscale (ILS): development of a brief measure of unit level implementation leadership.
Implementation Science, 9, 1-10 (Figure 1).
Image credit: Ikuko Sakai of Chiba University
Image license: Original content
Usage restrictions: Cannot be reused without permission.
In nursing, evidence-based practice (EBP) entails providing holistic, high-quality care based on
the most recent research and information rather than traditional methods or personal beliefs.
EBP is viewed as the gold standard for delivering the highest standards in clinical practice andpatient outcomes. Yet, there are several hurdles to EBP implementation. It is difficult for staff
nurses to tackle the implementation of EBP on their own as they lack managerial skills. Nursemanagers, on the other hand, can influence how team members cooperate to adopt EBP as
well as the attributes of the workplace. As a result, strategic leadership in the workplace bynurse managers is a vital facet of EBP implementation.
The implementation leadership scale (ILS) assesses strategic leadership shown by managers
in EBP implementation. It was originally developed by Aarons et al.* (University of California,San Diego) to implement EBPs in clinical settings and to develop successful intervention
programs. However, the individual characteristics of managers that contribute to their ILS
scores are not fully understood across the globe.
To help better integrate findings from research studies into clinical practice, Professor Ikuko
Sakai and a team of researchers recently developed and validated a Japanese version of theILS. The team is comprised of Masatoshi Saiki from Chiba University, Ai Tomotaki from TokaiUniversity, Hiroki Fukahori from Keio University, Takeshi Yamamoto from Sapporo MedicalUniversity, Masakazu Nishigaki from International University of Health and Welfare, Chiyo
Matsuoka from Konan Women’s University, and Emi Yasuda from the National Institute ofPublic Health. Their findings were published in the Journal of Nursing Management onOctober 23, 2023.
Prof. Sakai says, “The ILS has been translated into other languages like Chinese, Greek, andNorwegian, and this Japanese version will enable more international comparative studies.”
The ILS is available in two versions: one for self-assessment of managers and another for staff
assessments. To create a Japanese version, the original ILS was translated into Japanese andwas then given to the clinical nurses for review and to confirm if it was valid. Next, theJapanese ILS was distributed as a web questionnaire to 119 nurse managers and 2,858 staff
nurses working in Japan to gather data on the strategic leadership demonstrated in EBPimplementation.
The confirmatory factor analysis (CFA) was used to determine its construct validity or whether
the Japanese version measures implementation leadership with the original construct. The
CFA analysis helped the researchers understand how proactive leadership, knowledgeableleadership, supportive leadership, and perseverant leadership contributed to the strategic
leadership of nurse managers.
For nurse managers, the validity of ILS was determined by comparing the scores based on
their educational background (high school/vocational school/junior college/graduation) andexperience in implementing EBP. The results showed that both versions of the Japanese ILS
could satisfactorily gauge the strategic leadership of nurse managers and were reliable. “We
found that nurse managers with more advanced education and experience with learning andworking on EBP had higher ILS scores,” Prof. Sakai confirms.
The team is optimistic that the translated ILS will advance the development of educational
programs designed to help implement EBP and help test their effectiveness. Prof. Sakai
explains, “Research on EBP and its implementation is progressing slowly in Japan, but I’m
confident the translated ILS will have a positive impact. It will expedite the transition fromdelivering patient care based on habitual practice to care that is the product of evidence
gained from primary research.”
About Professor Ikuko Sakai
Dr. Ikuko Sakai is a Professor in the Department of Advanced Clinical Nursing at Chiba
University, Japan. She received her nursing degree from Chiba University and her Ph.D. fromThe University of Tokyo. Prof. Sakai’s research interests focus on evaluating the outcomes ofinter-professional education, nursing systems management, gerontological and community
health nursing, and implementing evidence-based practice in rehabilitation units. She has
published more than 100 publications consisting of peer-reviewed articles, books, and bookchapters over the last two decades.
Funding:
This study was supported by KAKENHI (No. 19H03955) from the Japan Society for Promotionof Science.
Reference:
Title of original paper: Reliability and Validity of the Japanese Version of theImplementation Leadership Scale for Nurse Managers and Staff Nurses: A Cross-Sectional
StudyAuthors: Masatoshi Saiki1, Ai Tomotaki2, Hiroki Fukahori3, Takeshi Yamamoto4, Masakazu
Nishigaki5, Chiyo Matsuoka6, Emi Yasuda7, and Ikuko Sakai1
Affiliations :1Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate
School of Nursing, Chiba University
2Faculty of Nursing, School of Medicine, Tokai University
3Faculty of Nursing and Medical Care, Keio University
4Department of Nursing, School of Health Sciences, Sapporo Medical University
5School of Nursing at Narita, International University of Health and Welfare
6Department of Nursing, Faculty of Nursing and Rehabilitation, Konan Women’s University
7Department of Health and Welfare Services, National Institute of Public HealthJournal: Journal of Nursing Management
DOI : 10.1155/2023/4080434
Contact: Ikuko Sakai
Graduate School of Nursing, Chiba University
Email: ikusakai@faculty.chiba-u.jp
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