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Li J, Zhang X. Role of middle managers in dealing with hierarchy and network logics: exploration in the context of Sino-Foreign Cooperative University. Front Psychol 2024; 15:1328675. [PMID: 38434948 PMCID: PMC10905615 DOI: 10.3389/fpsyg.2024.1328675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
While organizations tend to introduce network mechanism to activate the potential of members in the hierarchical dominated context, it is not clear how individual members deal with the complexity caused by two logics of hierarchy and network. To address this gap, this study focuses on the role of middle managers in collaborating with others in the multiple-logic complexity. We identify three types of collaboration scenarios, top-down, bottom-up, and horizontal, through 27 semi-structured interviews within a Sino-Foreign Cooperative University from 2021 to 2023. Guided by the grounded theory approach, we conceptualize the composite role of middle managers as the translucent hand of explicit and implicit connections, which help us to interpret middle managers' tangibly and intangibly impact under a hybrid organization context. The empirical results also reveal that the boundary perception of authority and responsibility as an important factor determines middle managers' awareness of power involvement in cooperation. The findings extend the understanding of middle managers in network organizations in the higher education context and provide suggestions for the dynamic role of middle managers and hybrid university management in the information age.
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Affiliation(s)
- Jiaxin Li
- Academy of Future Education, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, United Kingdom
| | - Xiaojun Zhang
- Academy of Future Education, Xi'an Jiaotong-Liverpool University, Suzhou, China
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2
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Henderikx M, Stoffers J. Digital transformation and middle managers' leadership skills and behavior: a group concept mapping approach. Front Psychol 2023; 14:1147002. [PMID: 37731886 PMCID: PMC10507628 DOI: 10.3389/fpsyg.2023.1147002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
This study, with the aim to test theory in practice, used group concept mapping to develop a comprehensive conceptualization of middle managers' leadership behaviors concerning digital transformation as a form of radical change. Participants were professionals in the largest public organization in the Netherlands (a police organization) who were dealing with digital transformation in their own practice and who enrolled in an education program on leadership and intelligence. Based on 94 unique statements, the participant-driven results revealed six thematically coherent clusters representing leadership skills and behaviors regarding improvement and results, digital technologies, cooperation, the self, change and ambivalence, and others. The stress value of 0.2234 indicated a good fit. Further analysis showed that clusters containing soft skills and people-oriented behaviors were considered the most important. These results can serve as input to support leadership development programs for middle managers to develop themselves into people-oriented, empowering leaders who can adapt their leadership approaches to fit and support change in general and technology-driven change in particular. Ultimately this will benefit their and their employees' overall well-being at work. This study is the first to investigate middle managers' leadership skills and behaviors in a large public organization that is entirely participant-driven.
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Affiliation(s)
- Maartje Henderikx
- Research Centre for Employability, Zuyd University of Applied Sciences, Sittard, Netherlands
- Faculty of Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Jol Stoffers
- Research Centre for Employability, Zuyd University of Applied Sciences, Sittard, Netherlands
- Faculty of Management, Open University of the Netherlands, Heerlen, Netherlands
- Research Centre for Education and the Labour Market (ROA), Maastricht University, Maastricht, Netherlands
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Boutcher F, Berta WB, Urquhart R, Gagliardi AR. A qualitative descriptive study of the role of nurse, allied health and physician middle managers who function as knowledge brokers in hospitals. Worldviews Evid Based Nurs 2022; 19:477-488. [PMID: 35726187 PMCID: PMC10084102 DOI: 10.1111/wvn.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge brokers (KB) are increasingly being employed in health care to implement evidence-based practice and improve quality of care. Middle managers (MMs) may play a KB role in the implementation of an innovative or evidence-based practice in hospitals. However, how MMs' broker knowledge in hospitals and their impact on practice has not been adequately studied. AIM To describe the role that MMs play in brokering knowledge in hospitals and their impact. METHOD A qualitative descriptive study was conducted to generate a detailed description of MM experiences as KBs in hospitals. Data were collected using semi-structured telephone interviews with MMs in Ontario, Canada. Participants were purposively sampled to ensure variation in MM characteristics and a diverse representation of perspectives. Data were collected and analyzed concurrently using an inductive constant comparative approach. RESULTS Twenty-one MMs from teaching and non-teaching hospitals participated. MMs described 10 roles and activities they enacted in hospitals that aligned with published KB roles. We found differences across professional groups and hospital type. Teaching status emerged as a potential factor relating to how MM KBs were able to function within hospitals. MMs reported enhanced patient, provider, and organizational outcomes. LINKING EVIDENCE TO ACTION Middle managers may play an important KB role in the implementation of evidence-based practice in hospitals. An improved understanding of the KB roles that MMs play may be important in boosting evidence base practice in health care to ultimately improve quality of care. Administrators need a better understanding of the current KB roles and activities MMs enact as this may lead to more organizational structures to support MM KBs in health care.
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Affiliation(s)
- Faith Boutcher
- Centre for Education and Knowledge Exchange in Aging, Baycrest Academy for Research and Education at Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
| | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robin Urquhart
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna R Gagliardi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Lidegaard LP, Kristiansen M, Pisinger C. Readiness for implementation of smoke-free work hours in private companies: A qualitative study of perceptions among middle managers. Tob Prev Cessat 2021; 7:38. [PMID: 34056145 PMCID: PMC8145195 DOI: 10.18332/tpc/134800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Workplaces are important settings for implementation of smoke-free environments. In this study, we follow a medical production company with 677 employees that implemented one of the most stringent tobacco policies legally possible in Denmark – smoke-free work hours – which means that employees are not allowed to smoke during work time. This study explores tobacco use restrictions during work hours regarding readiness of implementation, focusing specifically on middle managers’ perceptions and considerations, as well as their perceived responsibility in enforcing these. METHODS A case study is presented. Two focus groups of 10 middle managers were conducted, seven months before smoke-free work hours were implemented. The facilitators used open-ended questions, which consisted of a structured section with specific themes related to the implementation of smoke-free work hours. Focus groups were recorded, transcribed, and analyzed thematically. RESULTS We identified five main themes: 1) Benefits of the new policy due to better health, lower sickness-related absences, increased productivity, and improved branding value; 2) Social interactions across smoking status; 3) Smoking is a private matter with ethical dimensions; 4) The role of middle managers and concerns about enforcement; and 5) Limited experience with resistance from the smoking employees. CONCLUSIONS The findings suggest that workplaces in the preparation phase should ensure that: 1) The middle managers gain training on how to talk with employees about smoking cessation; 2) The middle managers are equipped to handle the new policy and have a joint vision and understanding of why and how they should enforce it; and 3) Room is made for discussions on resistance and enforcement-related challenges as well as ethical issues.
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Affiliation(s)
- Lærke P Lidegaard
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotta Pisinger
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark.,Center for Healthy Aging, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
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Baixauli E, Beleña Á, Díaz A. Evaluation of the Effects of a Bullying at Work Intervention for Middle Managers. Int J Environ Res Public Health 2020; 17:E7566. [PMID: 33080951 DOI: 10.3390/ijerph17207566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
The aim of the study is to evaluate the effects of a workplace bullying intervention based on the training of middle managers regarding bullying awareness, the consequences of bullying, strategies in conflict resolution and mediation/negotiation abilities. Overall, 142 randomly selected middle managers participated in the study. First, participants completed an information record and two scales assessing bullying strategies, role conflict and role ambiguity. The last two scales were completed again in a second phase three months after the intervention had finished. The intervention produced a decrease in the following bullying strategies: effects on self-expression and communication, effects on personal reputation and effects on occupational situation and quality of life, with all of the mentioned bullying strategies being suffered by part of the sample. In addition, the conflict role decreased in the group which received the intervention. Moreover, the decrease in the effects of the bullying strategy effects on occupational situation and quality of life was especially important in managers with higher responsibilities within the workplace. Results are discussed in the framework that (1) leadership practices and, more specifically, conflict resolution skills are strongly responsible for bullying at work; and (2) the importance of intervening in the early stages of the bullying process as a key element in the correction, but also as a potential prevention element, of bullying in the workplace.
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Sigursteinsdóttir H, Skúladóttir H, Agnarsdóttir T, Halldórsdóttir S. Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Nursing Unit Managers. Int J Environ Res Public Health 2020; 17:ijerph17020673. [PMID: 31968675 PMCID: PMC7014039 DOI: 10.3390/ijerph17020673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 12/02/2022]
Abstract
Background: Middle managers have not received enough attention within the healthcare field, and little is known how stressful factors in their work environment coupled with a lack of adequate sleep are related to musculoskeletal pain. The aim of this study was to examine the correlation between stressful factors in the work environment, lack of adequate sleep, and pain/discomfort in three body areas. Methods: Questionnaire was sent electronically to all female nursing unit managers (NUM) in Iceland through the outcome-survey system. The response rate was 80.9%. Results: NUM who had high pain/discomfort in the neck area also had very high pain/discomfort in the shoulder area and pain in the lower back. The results also revealed positive a medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Stress in daily work, mental strain at work, and being under time-pressures had hardly any correlation with pain/discomfort in the three body parts. Adequate sleep had a significant negative correlation with all stressful factors in the work environment and all three body parts under review. Conclusion: The results will hopefully lead to a better consideration of stressful factors in the work environment, sleep, and musculoskeletal pain in middle managers.
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Affiliation(s)
- Hjördís Sigursteinsdóttir
- School of Business and Science, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland
- Correspondence:
| | - Hafdís Skúladóttir
- School of Health Sciences, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland; (H.S.); (S.H.)
| | - Thórey Agnarsdóttir
- Environmental and Public Health Authority, Furuvellir 1, 600 Akureyri, Iceland
| | - Sigrídur Halldórsdóttir
- School of Health Sciences, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland; (H.S.); (S.H.)
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Sørly R, Krane MS, Bye G, Ellingsen MB. "There Is a Lot of Community Spirit Going On." Middle Managers' Stories of Innovation in Home Care Services. SAGE Open Nurs 2019; 5:2377960819844367. [PMID: 33415236 PMCID: PMC7774439 DOI: 10.1177/2377960819844367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background: There is a need for qualitative studies on imposed innovation in
home care services in welfare societies. The municipalities are key actors in the field of
innovation in the public sector. As innovations often are interpreted to be in conflict
with values in health care, we need knowledge on how policy changes and imposed
innovations are understood and handled by middle managers working in the sector.
Aim: We aim to explore how middle managers react to imposed innovation in
health services through their storytelling. The research question was “What can middle
managers' stories of imposed innovation tell us about their role in, and some important
prerequisites for, innovation processes in municipal health-care services?”
Methods: A narrative study of experiences with municipal innovation among
middle managers in Norway. In this article, we do a thematic analysis of interviews with
seven female middle managers who work in a home care service department.
Findings: The study develops an understanding of which frameworks are
required within a home care service to meet constant demands for innovation. Innovations
are understood by the managers as results of policy changes and new public management
demands and as a troublesome burden. We find the prerequisites for implementing
innovations to be (1) trust-based management, (2) flexibility and
dynamics, (3) continuity of care, and (4) emphasis on
competence. These prerequisites are further interpreted in relation to dominant
discourses on innovation at the macro, meso, and micro levels within the storytelling
contexts. Conclusion: Imposed innovations require a negotiating practice in
cross-disciplinary environments at all levels in the organization.
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Urquhart R, Kendell C, Folkes A, Reiman T, Grunfeld E, Porter GA. Making It Happen: Middle Managers' Roles in Innovation Implementation in Health Care. Worldviews Evid Based Nurs 2018; 15:414-423. [PMID: 30291739 PMCID: PMC6518932 DOI: 10.1111/wvn.12324] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 11/29/2022]
Abstract
Background Middle managers are given scant attention in the implementation literature in health care, where the focus is on senior leaders and frontline clinicians. Aims To empirically examine the role of middle managers relevant to innovation implementation and how middle managers experience the implementation process. Methods A qualitative study was conducted using the methods of grounded theory. Data were collected through semistructured interviews with middle managers (N = 15) in Nova Scotia and New Brunswick, Canada. Participants were purposively sampled, based on their involvement in implementation initiatives and to obtain variation in manager characteristics. Data were collected and analyzed concurrently, using an inductive constant comparative approach. Data collection and analysis continued until theoretical saturation was reached. Results Middle managers see themselves as being responsible for making implementation happen in their programs and services. As a result, they carry out five roles related to implementation: planner, coordinator, facilitator, motivator, and evaluator. However, the data also revealed two determinants of middle managers' role in implementation, which they must negotiate to fulfill their specific implementation roles and activities: (1) They perform many other roles and responsibilities within their organizations, both clinical and managerial in nature, and (2) they have limited decision‐making power with respect to implementation and must work within the parameters set by upper levels of the organization. Linking Evidence to Action Middle managers play an important role in translating adoption decisions into on‐the‐ground implementation. Optimizing their capacity to fulfill this role may be key to improving innovation implementation in healthcare organizations.
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Affiliation(s)
- Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cynthia Kendell
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amy Folkes
- Central Health Regional Health Authority, Grand Falls-Windsor, Newfoundland and Labrador, Canada
| | - Tony Reiman
- Department of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffery A Porter
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Urquhart R, Kendell C, Folkes A, Reiman T, Grunfeld E, Porter G. Factors influencing middle managers' commitment to the implementation of innovations in cancer care. J Health Serv Res Policy 2018; 24:91-99. [PMID: 30290703 DOI: 10.1177/1355819618804842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify and illuminate influences on middle managers' commitment to innovation implementation. METHODS A qualitative study was conducted, employing the methods of grounded theory. Semi-structured interviews were used to collect data from middle managers (n = 15) in Nova Scotia and New Brunswick, Canada. Data were collected and analysed concurrently, using an inductive constant comparative approach. Data collection and analysis continued until theoretical saturation was reached. RESULTS The data revealed middle managers contemplate two central issues in terms of their commitment to implementation, that is whether or not they fully engage in and support the implementation of a particular innovation. These issues are (1) ease of implementation and (2) potential benefit for patients. Middle managers' views and expectations related to ease of implementation are influenced by available resources, fit with setting, and stakeholder buy-in. Their views on patient benefit are influenced by external evidence of benefit and local gaps in care. CONCLUSIONS These findings provide further insight into the factors that influence middle managers' commitment to innovation implementation, and how middle managers consider these factors in the context of their work settings.
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Affiliation(s)
- Robin Urquhart
- 1 Assistant Professor, Department of Surgery, Dalhousie University, Canada.,2 Affiliate Scientist, QEII Health Sciences Centre, Nova Scotia Health Authority, Canada.,3 Assistant Professor, Department of Community Health & Epidemiology, Dalhousie University, Canada
| | - Cynthia Kendell
- 4 Research Associate, Department of Surgery, Dalhousie University, Canada
| | - Amy Folkes
- 5 Access and Clinical Efficiency Manager, Central Health Regional Health Authority, Newfoundland and Labrador, Canada
| | - Tony Reiman
- 6 Professor, Department of Medicine, Dalhousie University, Canada.,7 Professor, Department of Biology, University of New Brunswick, Canada.,8 Medical Oncologist, Department of Oncology, Saint John Regional Hospital, Canada
| | - Eva Grunfeld
- 9 Professor, Department of Family and Community Medicine, University of Toronto, Canada
| | - Geoff Porter
- 10 Professor, Department of Surgery, Dalhousie University, Canada.,11 Surgical Oncologist, QEII Health Sciences Centre, Nova Scotia Health Authority, Canada.,12 Professor, Department of Community Health & Epidemiology, Dalhousie University, Canada
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Spencer C, McLaren S. Empowerment in nurse leader groups in middle management: a quantitative comparative investigation. J Clin Nurs 2017; 26:266-279. [PMID: 27291299 DOI: 10.1111/jocn.13426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups. BACKGROUND Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes. DESIGN Quantitative component of a mixed methods study using survey principles. METHODS The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics. RESULTS Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support. CONCLUSIONS A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures. RELEVANCE TO CLINICAL PRACTICE Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement.
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Affiliation(s)
| | - Susan McLaren
- Department of Health and Social Care, London South Bank University, London, UK
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Carrillo I, Mira JJ, Vicente MA, Fernandez C, Guilabert M, Ferrús L, Zavala E, Silvestre C, Pérez-Pérez P. Design and Testing of BACRA, a Web-Based Tool for Middle Managers at Health Care Facilities to Lead the Search for Solutions to Patient Safety Incidents. J Med Internet Res 2016; 18:e257. [PMID: 27678308 PMCID: PMC5059483 DOI: 10.2196/jmir.5942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/03/2016] [Accepted: 09/06/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lack of time, lack of familiarity with root cause analysis, or suspicion that the reporting may result in negative consequences hinder involvement in the analysis of safety incidents and the search for preventive actions that can improve patient safety. OBJECTIVE The aim was develop a tool that enables hospitals and primary care professionals to immediately analyze the causes of incidents and to propose and implement measures intended to prevent their recurrence. METHODS The design of the Web-based tool (BACRA) considered research on the barriers for reporting, review of incident analysis tools, and the experience of eight managers from the field of patient safety. BACRA's design was improved in successive versions (BACRA v1.1 and BACRA v1.2) based on feedback from 86 middle managers. BACRA v1.1 was used by 13 frontline professionals to analyze incidents of safety; 59 professionals used BACRA v1.2 and assessed the respective usefulness and ease of use of both versions. RESULTS BACRA contains seven tabs that guide the user through the process of analyzing a safety incident and proposing preventive actions for similar future incidents. BACRA does not identify the person completing each analysis since the password introduced to hide said analysis only is linked to the information concerning the incident and not to any personal data. The tool was used by 72 professionals from hospitals and primary care centers. BACRA v1.2 was assessed more favorably than BACRA v1.1, both in terms of its usefulness (z=2.2, P=.03) and its ease of use (z=3.0, P=.003). CONCLUSIONS BACRA helps to analyze incidents of safety and to propose preventive actions. BACRA guarantees anonymity of the analysis and reduces the reluctance of professionals to carry out this task. BACRA is useful and easy to use.
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Affiliation(s)
- Irene Carrillo
- Health Psychology Department, Miguel Hernández University, Elche, Spain.
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12
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Nzinga J, Mbaabu L, English M. Service delivery in Kenyan district hospitals - what can we learn from literature on mid-level managers? Hum Resour Health 2013; 11:10. [PMID: 23442524 PMCID: PMC3599555 DOI: 10.1186/1478-4491-11-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level managers to help us understand how they might influence service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments who are also clinical or nursing service providers might play. METHODS A computerized search strategy was run in Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to 2011. In addition, citation searching from excluded and included articles was used and relevant unpublished literature systematically identified. RESULTS AND DISCUSSION A total of 23 articles were finally included in the review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, we identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. The majority of studies included in the review concerned the roles that mid-level managers are expected to play in times of organizational change. CONCLUSION This review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan public hospitals and strongly suggests that approaches to strengthen this level of management will be valuable. The findings from this review should also help inform empirical studies of the roles of mid-level managers in these settings.
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Affiliation(s)
- Jacinta Nzinga
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi 00100, PO Box 43640, Nairobi, Kenya
| | - Lairumbi Mbaabu
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi 00100, PO Box 43640, Nairobi, Kenya
| | - Mike English
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi 00100, PO Box 43640, Nairobi, Kenya
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, Oxford, UK
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Abstract
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.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill 1107-A McGavran-Greenberg Campus Box 7411 Chapel Hill, NC 27599-7411, USA
| | - Shoou-Yih Daniel Lee
- Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, Michigan 48109-2029, USA
| | - Bryan J Weiner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill 27599-7411, USA
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