Leadership refers to the actions of formal leaders on a unit that influence change and promote excellence in practice and resident care. Formal leaders will vary according to the care provider completing the ACT; for example, with care aides, a variety of: care managers, RNs, and/or LPNs can be selected as ‘formal leaders’. Individuals completing the ACT are asked to rate this leader by answering six items using a 5-point Likert agreement scale ranging from 1 (strongly disagree) to 5 (strongly agree). The final leadership score obtained for each individual is an average of his or her scores on the six items. Higher scores reflect a more positive perception of the leadership on the care unit.