title: Implementing complex innovations: factors influencing middle manager support.
abstract: BACKGROUND
  Middle manager resistance is often described as a major challenge for upper-level administrators seeking to implement complex innovations such as evidence-based protocols or new skills training. However, factors influencing middle manager support for innovation implementation are currently understudied in the U.S. health care literature.
  
  
  OBJECTIVE
  This article examined the factors that influence middle managers' support for and participation in the implementation of work-based learning, a complex innovation adopted by health care organizations to improve the jobs, educational pathways, skills, and/or credentials of their frontline workers.
  
  
  METHODS
  We conducted semistructured interviews and focus groups with 92 middle managers in 17 health care organizations. Questions focused on understanding middle managers' support for work-based learning as a complex innovation, facilitators and barriers to the implementation process, and the systems changes needed to support the implementation of this innovation.
  
  
  RESULTS
  Factors that emerged as influential to middle manager support were similar to those found in broader models of innovation implementation within the health care literature. However, our findings extend previous research by developing an understanding about how middle managers perceived these constructs and by identifying specific strategies for how to influence middle manager support for the innovation implementation process. These findings were generally consistent across different types of health care organizations.
  
  
  CONCLUSIONS
  Study findings suggest that middle manager support was highest when managers felt the innovation fit their workplace needs and priorities and when they had more discretion and control over how it was implemented. Leaders seeking to implement innovations should consider the interplay between middle managers' control and discretion, their narrow focus on the performance of their own departments or units, and the dedication of staff and other resources for empowering their managers to implement these complex innovations.
authors.affiliation: Department of Mental Health Law and Policy, University of South Florida, Tampa, USA. echuang@usf.edu
authors.forename: Emmeline
authors.initials: E
authors.lastname: Chuang
authors.forename: Kendra
authors.initials: K
authors.lastname: Jason
authors.forename: Jennifer Craft
authors.initials: JC
authors.lastname: Morgan
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D005260:Female; D017144:Focus Groups; D006295:Health Resources / Q000600:supply & distribution; D006740:Hospital Administrators; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D016134:Organizational Policy; D014481:United States