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BMJ Open. 2018 Jun 30;8(6):e021992. doi: 10.1136/bmjopen-2018-021992.

How do iLead? Validation of a scale measuring active and passive implementation leadership in Swedish healthcare.

Author information

Department of Learning, Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Unit for Implementation and Evaluation, Centre for Epidemiology and Community Medicine (CES), Stockholm County Council, Stockholm, Sweden.
School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.



This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale.


Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses.


The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (χ2(99)=382.864**, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory.


The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.


CFA; full-range leadership model; implementation leadership; scale; validation

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