What roles do middle managers play in implementation of innovative practices?
Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices.



The aim of this study was to expand the understanding of middle managers' influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks.



We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities.



Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups.



Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts.
Ryann L. Engle, MPH, is Health Science Specialist and Senior Project Manager, Center for Healthcare Organization and Implementation Research (CHOIR), Department of Veterans Affairs, Boston, Massachusetts. E-mail: ryann.engle@va.gov. Emily R. Lopez, MPH, is Project Coordinator, Department of Enabling Technology, McKesson Specialty Health, The Woodlands, Texas. Katelyn E. Gormley, MPH, is Project Manager, CHOIR, Department of Veterans Affairs, Boston, Massachusetts. Jeffrey A. Chan, BS, is Senior Project Manager, CHOIR, Department of Veterans Affairs, Boston, Massachusetts. Martin P. Charns, DBA, is Co-director, CHOIR, Department of Veterans Affairs, and Professor of Health Policy and Management, Boston University School of Public Health, Massachusetts. Carol VanDeusen Lukas, EdD, is Senior Investigator, CHOIR, Department of Veterans Affairs, and Clinical Associate Professor, Boston University School of Public Health, Massachusetts.
Ryann L
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Emily R
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Lopez
Katelyn E
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Jeffrey A
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Martin P
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Carol VanDeusen
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Lukas
D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D006740:Hospital Administrators; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D015279:Organizational Culture; D058996:Quality Improvement; D014481:United States