Assessing Clinical Leadership in Nursing: Development and Validation of the Clinical Leadership Self-Awareness Tool (CLeaSAT)

Background Clinical leadership is essential for high-quality care, team effectiveness, and workforce sustainability in healthcare. Despite growing recognition of its importance, leadership research and assessment tools predominantly focus on formal leadership roles and transformational leadership models. Consequently, informal, practice-based clinical leadership behaviours demonstrated by frontline healthcare professionals (HCPs) remain insufficiently captured. In addition, existing instruments offer limited support for developing self-awareness of such behaviours. This study aimed to develop and validate the Clinical Leadership Self-Awareness Tool (CLeaSAT), designed to measure informal clinical leadership behavioural indicators among HCPs. Methods A mixed-methods design was used, following established guidelines for scale development and psychometric validation. The process comprised three phases: item development, scale development, and scale evaluation. Items were generated through a literature review, focus groups, and individual interviews with healthcare professionals, educators, and managers. Content validity was assessed via face validity and a two-round Delphi procedure with clinical leadership experts. The questionnaire was administered to healthcare professionals from four Flemish hospitals (Belgium). Exploratory Factor Analysis using principal axis factoring with varimax rotation examined the factor structure. Internal consistency was evaluated using Cronbach’s alpha and corrected item–total correlations. Criterion validity was assessed using Pearson correlations with the Clinical Leadership Survey (CLS). Results Data from 229 healthcare professionals were analysed. Exploratory factor analysis supported a five-factor structure comprising 32 items: clinical expertise, effective communication, flexibility, continuous learning and improvement, and vision on care. The model explained 51.9% of the total variance. The overall scale demonstrated excellent internal consistency (Cronbach’s α = 0.92), with acceptable to strong reliability across subscales (α = 0.75–0.82). Corrected item–total correlations ranged from 0.37 to 0.62. Criterion validity was supported by a strong correlation with the CLS (r = 0.77, p < 0.001). Conclusions The CLeaSAT is a valid and reliable tool for assessing self-awareness of informal clinical leadership behaviours among healthcare professionals. By focusing on observable, practice-based leadership behaviours rather than formal roles, the tool addresses an important gap in leadership assessment and supports leadership development in healthcare settings.