title: From strategy to action: how top managers' support increases middle managers' commitment to innovation implementation in health care organizations.
abstract: BACKGROUND
  Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation.
  
  
  METHODS
  We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data.
  
  
  RESULTS
  We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation.
  
  
  CONCLUSIONS
  Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.
authors.affiliation: Sarah A. Birken, PhD, is Postdoctoral Fellow, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. E-mail: sarah1@email.unc.edu.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Birken
authors.forename: Shoou-Yih Daniel
authors.initials: SY
authors.lastname: Lee
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
authors.forename: Michael
authors.initials: M
authors.lastname: Chiu
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Schaefer
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D006270:Health Facility Administrators / Q000458:organization & administration; D006276:Health Facility Size / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D009936:Organizational Innovation; D011795:Surveys and Questionnaires; D014481:United States