The Healthcare Leadership Competency Questionnaire (HLCQ): development and psychometric evaluation

BACKGROUND: Leadership is an important competency in healthcare, but few instruments assess leadership competencies across healthcare professions. AIM: To develop and evaluate the psychometric properties of the Healthcare Leadership Competency Questionnaire (HLCQ). METHODS: This methodological study comprised questionnaire development and psychometric validation. Items were developed through literature review, multidisciplinary expert review, and cognitive interviews. The validation sample was randomly divided into exploratory (60%) and confirmatory (40%) samples. Exploratory factor analysis (EFA) informed item reduction, followed by confirmatory factor analysis (CFA). Reliability and convergent and discriminant validity were assessed. RESULTS: A total of 1,171 healthcare professionals were included in the psychometric evaluation, with 705 assigned to the EFA sample and 466 to the CFA sample. EFA of the initial 47-item questionnaire supported a four-factor solution accounting for 38.9% of the total variance. Iterative item reduction resulted in a final 35-item questionnaire. CFA provided overall support for the four-factor structure, although fit indices were mixed (CFI = 0.896; TLI = 0.888; RMSEA = 0.070; SRMR = 0.075). Cronbach's α ranged from 0.601 to 0.896 and composite reliability from 0.671 to 0.906 across the four factors. HTMT values ranged from 0.374 to 0.811, supporting discriminant validity. CONCLUSIONS: The HLCQ showed a four-dimensional structure and generally satisfactory initial psychometric properties. The findings support its further evaluation as a measure of leadership competencies among healthcare professionals, while additional evidence is needed for some dimensions and across independent healthcare settings.