Implementation Science | |
Uncovering middle managers' role in healthcare innovation implementation | |
Bryan J Weiner2  Shoou-Yih Daniel Lee1  Sarah A Birken3  | |
[1] Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, Michigan 48109-2029, USA;Department of Health Policy and Management, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill 27599-7411, USA;Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill 1107-A McGavran-Greenberg Campus Box 7411 Chapel Hill, NC 27599-7411, USA | |
关键词: Innovation implementation; Healthcare; Middle managers; | |
Others : 828844 DOI : 10.1186/1748-5908-7-28 |
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received in 2011-08-05, accepted in 2012-04-03, 发布年份 2012 | |
【 摘 要 】
Background
Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations.
Discussion
Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation.
Summary
Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.
【 授权许可】
2012 Birken et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20140714040213827.pdf | 310KB | download | |
Figure 1. | 28KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Blancett SS, Flarey DL: Reengineering Nursing and Healthcare: The Handbook for Organizational Transformation Citation. Gaithersburg: Aspen Publishers; 1995.
- [2]Noble CH: The eclectic roots of strategy implementation research. J Bus Res 1999, 45:119-134.
- [3]Bourne L, Walker DHT: The paradox of project control. Team Perform Manage 2005, 11:157-178.
- [4]McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA: The quality of healthcare delivered to adults in the United States. N Engl J Med 2003, 348:2635-2645.
- [5]Halle M, Lewis CB, Sheshamani M, Health disparities: A case for closing the gap. US Department of Health and Human Services. [http://www.healthreform.gov/reports/healthdisparities/disparities_final.pdf] webcite 2009.
- [6]Agency for Healthcare Research and Quality: Women's Healthcare in the United States: Selected Findings from the 2004 National healthcare Quality and Disparities Reports. Rockville. 2004.
- [7]Safran DG, Karp M, Koltin K, Chang H, Li A, Ogren J, Rogers WH: Measuring patients' experiences with individual primary care physicians. J Gen Intern Med 2006, 21:13-21.
- [8]Campbell EG, Singer S, Kitch BT, Iezzoni LI, Meyer GS: Patient safety climate in hospitals: act locally on variation across units. Jt Comm J Qual Patient Saf 2010, 36:319-326.
- [9]Alexander JA: Quality Improvement in Healthcare Organizations: A Review of Research on QI Implementation. Institute of Medicine; 2008.
- [10]Shortell SM, Bennett CL, Byck GR: Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q 1998, 76:593-624.
- [11]Calvo A: HRSA Health Disparities Collaboratives 2006. US Department of Health and Human Services. Health Resources and Services Administration. Bureau of Primary Health Care. Division of Clinical Quality Available at http://mchb.hrsa.gov/researchdata/mchirc/dataspeak/pastevent/may172006/files/acalvo.ppt webcite. Accessed April 27, 2012
- [12]Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Q 1996, 74:511-544.
- [13]Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C: Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Patient Saf 2001, 27:63-80.
- [14]Rogers EM: Diffusion of Innovations. 5th edition. New York, NY: Free Press; 2003.
- [15]Chin MH, Cook S, Drum ML, Jin L, Guillen M, Humikowski CA, Koppert J, Harrison JF, Lippold S, Schaefer CT: Improving diabetes care in Midwest community health centers with the Health Disparities Collaborative. Diabetes Care 2004, 27(7):2.
- [16]Klein KJ, Sorra JS: The challenge of innovation implementation. Acad Manage Rev 1996, 21:1055-1080.
- [17]Linnan L, Steckler AB: Process evaluation for public health interventions and research: an overview. In Process evaluation for public health interventions and research. Edited by Steckler AB, Linnan L. San Francisco: Jossey-Bass; 2002:1-24.
- [18]Moncher FJ, Prinz RJ: Treatment fidelity in outcome studies. Clin Psychol Rev 1991, 11:247-266.
- [19]Blumenthal D, Kilo CM: A report card on continuous quality improvement. Milbank Q 1998, 76:625-648.
- [20]Kralovec PJ: Clinical quality improvement without fear. Healthc Forum J 1990, 33:32-34.
- [21]Fischer LR, Solberg LI, Zander KM: The failure of a controlled trial to improve depression care: a qualitative study. Jt Comm J Qual Patient Saf 2001, 27:639-650.
- [22]Levinson W, D'Aunno T, Gorawara-Bhat R, Stein T, Reifsteck S, Egener B, Dueck R: Patient-physician communication as organizational innovation in the managed care setting. Am J Manag Care 2002, 8:622-630.
- [23]Palinkas LA, Schoenwald SK, Hoagwood K, Landsverk J, Chorpita BF, Weisz JR: An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. Psychiatr Serv 2008, 59:738-746.
- [24]Helfrich CD, Weiner BJ, McKinney MM, Minasian L: Determinants of implementation effectiveness - Adapting a framework for complex innovations. Med Care Res Rev 2007, 64:279-303.
- [25]Aarons GA, Sommerfeld DH, Walrath-Greene CM: Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implement Sci 2009, 4:13. BioMed Central Full Text
- [26]Flanagan ME, Ramanujam R, Doebbeling BN: The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance. Implement Sci 2009, 4:10. BioMed Central Full Text
- [27]Proctor EK, Knudsen KJ, Fedoravicius N, Hovmand P, Rosen A, Perron B: Implementation of evidence-based practice in community behavioral health: agency director perspectives. Adm Policy Ment Health Ment Health Serv Res 2007, 34:479-488.
- [28]Kimberly J, Cook JM: Organizational measurement and the implementation of innovations in mental health services. Adm Policy Ment Health Ment Health Serv Res 2008, 35:11-20.
- [29]Weiner BJ, Shortell SM, Alexander JA: Promoting clinical involvement in the hospital quality improvement efforts: the effects of top management, board, and physician leadership. Heal Serv Res 1997, 63:29-57.
- [30]Aarons GA: Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatr Serv 2006, 57:1162-1169.
- [31]Fremont AM, Joyce G, Anaya HD, Bowman CC, Halloran JP, Chang SW, Bozzette SA, Asch SM: An HIV collaborative in the VHA: do advanced HIT and one-day sessions change the collaborative experience? Jt Comm J Qual Patient Saf 2006, 32:324-336.
- [32]Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O'Connor PJ, Ohnsorg KA, Rolnick SJ: Lessons from experienced guideline implementers: Attend to many factors and use multiple strategies. J Qual Improv 2000, 26:171.
- [33]Tucker AL, Nembhard IM, Edmondson AC: Implementing new practices: an empirical study of organizational learning in hospital intensive care units. Manag Sci 2007, 53:894-907.
- [34]Freed DH: Hospital turnarounds: agents, approaches, alchemy. Healthcare Manager 2005, 24(23):96.
- [35]Floyd SW, Wooldridge B: Middle management's strategic influence and organizational performance. J Manag Stud 1997, 34:465-485.
- [36]King AW, Zeithaml CP: Competencies and firm performance: examining the causal ambiguity paradox. Strateg Manag J 2001, 22:75-99.
- [37]Floyd SW, Wooldridge B: Managing strategic consensus: the foundation of effective implementation. Acad Manag Exec 1992, 6:27-39.
- [38]Maritan CA, Brush TH: Heterogeneity and transferring practices: implementing flow manufacturing in multiple plants. Strateg Manag J 2003, 24:945-959.
- [39]Mair J: Exploring the determinants of unit performance: the role of middle managers in stimulating profit growth. Group Organ Manage 2005, 2005:263.
- [40]Sayer K: Denying the technology: middle management resistance in business process re-engineering. J Inf Technol 1998, 13:247.
- [41]Huy QN: Emotional balancing of organizational continuity and radical change: the contribution of middle managers. Adm Sci Q 2002, 47:31-69.
- [42]Danford MD: Middle management resist lean implementation, survey suggests. Mod Mach Shop 2007, 80:42.
- [43]Ogbonna E, Wilkinson B: The false promise of organizational culture change: a case study of middle managers in grocery retailing. J Manag Stud 2003, 40:1151-1178.
- [44]Birken S: Where the rubber meets the road: A mixed-method study of middle managers' role in innovation implementation in healthcare organizations. PhD thesis. University of North Carolina at Chapel Hill, Department of Health Policy and Management; 2011.
- [45]Scott J: Social Network Analysis. London: Sage; 1991.
- [46]Kanfer R, Ackerman PL, Sternberg RJ: Dynamics of skill acquisition: building a bridge between intelligence and motivation. Adv Psychol Hum Intell 1989, 5:83-134.
- [47]Ackerman PL, Kyllonen PC, Morrison JE: Trainee characteristics. In Training for performance: Principles of applied human learning. Edited by Morrison JE. Oxford: John Wiley & Sons; 1991:193-229.
- [48]Klein KJ, Conn AB, Sorra JS: Implementing computerized technology: An organizational analysis. J Appl Psychol 2001, 86:811-824.
- [49]Weiner BJ, Lewis MA, Linnan LA: Using organizational theory to understand the determinants of effective implementation of worksite health promotion programs. Heal Educ Res 2009, 24:292-305.
- [50]Huy QN: In praise of middle managers. Har Bus Rev 2001, 79:72-79.
- [51]Currie G, Proctor SJ: The antecedents of middle managers' strategic contribution: the case of a professional bureaucracy. J Manag Stud 2005, 42:1325-1356.
- [52]Balogun J: From blaming the middle to harnessing its potential: creating change intermediaries. Br J Manag 2003, 14:69-83.
- [53]Schilit WK, Locke EA: A study of upward influence in organizations. Adm Sci Q 1982, 27:304-316.
- [54]Dutton JE, Ashford SJ: Selling issues to top management. Acad Manag Rev 1993, 18:397-428.
- [55]Dopson S, Stewart R: What is happening to middle management? Br J Manag 1990, 1:3-16.
- [56]Mantere S: Strategic practices as enablers and disablers of championing activity. Strateg Organ 2005, 3:157-184.
- [57]Pappas JM: Middle managers' strategic influence: Investigating network centrality and perceptual deviance. In Academy of Management Proceedings: 6-11 August 2004. New Orleans; C1-C6.
- [58]Uyterhoeven HER: General managers in the middle. Harv Bus Rev 1972, 50:75-85.
- [59]Kanter RM: The middle manager as innovator. Harv Bus Rev 1982, 60:95-105.
- [60]Kodama M: Knowledge creation through networked strategic communities. Long Range Planning 2005, 38:27-49.
- [61]Starr P: The Social Transformation of American Medicine. New York, NY: Basic Books; 1982.
- [62]Rouleau L: Micro-practices of strategic sensemaking and sensegiving: how middle managers interpret and sell change every day. J Manag Stud 2005, 42:1413.
- [63]Eisenberger R, Huntington R, Hutchison S, Sowa D: Perceived Organizational Support. J Appl Psychol 1986, 71:500-507.
- [64]Levinson H: Reciprocation: the relationship between man and organization. Adm Sci Q 1965, 9:370-390.
- [65]Federico F, Bonacum D: Strengthening the core: middle managers play a vital role in improving safety. Healthc Exec 2010, 25:68-70.
- [66]Floyd SW, Wooldridge B: Middle management involvement in strategy and its association with strategic type: a research note. Strateg Manag J 1992, 13:153-167.