How is leadership behavior associated with organization-related variables? Translation and psychometric evaluation of the implementation leadership scale in German primary healthcare
Authors: Söling Sara , Pfaff Holger , Karbach Ute , Ansmann Lena , Köberlein-Neu Juliane ,   AdAM-Study Group, Kellermann-Mühlhoff Petra , Düvel Lara , Beckmann Till , Hammerschmidt Reinhard , Jachmich Julia , Leicher Eva , Brandt Benjamin , Richard Johanna , Meyer Frank , Flume Mathias , Müller Thomas , Gerlach Ferdinand M. , Muth Christiane , Gonzalez-Gonzalez Ana Isabel , Chapidi Kiran , Brünn Robin , Ihle Peter , Meyer Ingo , Timmesfeld Nina , Trampisch Hans J. , Klaaßen-Mielke Renate , Basten Jale , Greiner Wolfgang , Suhrmann Bastian , Piotrowski Alexandra , Beifuß Karolina , Meyer Sarah , Grandt Daniel , Grandt Simone 
Published: August 2022

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.