From strategy to action

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 US health centers to assess whether top managers’ support influences middle managers’ commitment directly, 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. Findings 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 = 0.09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95 percent CI: 0.03, 0.17); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications Top managers can demonstrate their support by directly 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.

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

“…In this study, the participation of both front line managers and senior managers in the intervention enabled senior managers to support the frontline managers in their implementation efforts. Support from senior managers, including help in prioritizing 35,36 and the opportunity to discuss problems or successes, 37 has been reported to be important for front line managers' commitment to implementation. Conversely, a lack of senior managers' support has a direct negative effect.…”

“…18,37,38 Moreover, it is essential that senior managers give continuous encouragement, pay attention to organizational priorities, and make resources available. [35][36][37]39 The benefits of including dyads of front line and senior managers in leadership interventions, while explicating their roles within the Gifford model, need further development and emphasis in future studies. Rather, the findings indicate a need for a stronger focus on developing particular leadership behaviors, both in operationalizing the implementation plans, and in supporting managers in applying the behaviors in their management practices.…”

Elaborating on theory with middle managers’ experience implementing healthcare innovations in practice

“…Middle managers—employees who are supervised by an organization’s top managers and who supervise frontline employees [1]—have received increased attention in recent healthcare innovation implementation research [2, 3]. This emerging literature suggests that middle managers influence innovation implementation by bridging informational gaps between top managers and frontline employees that might otherwise impede innovation implementation [1–3].…”

“…Although the theory has received some empirical support [2, 3], the extent to which it aligns with middle managers’ experience in practice is unclear. The objectives of this study were to (1) assess alignment between middle managers’ experience and the theory’s hypothesized roles and activities and (2) elaborate on the theory with examples from middle managers’ experience.…”

Challenges of implementation and implementation research: Learning from an intervention study designed to improve tumor registry reporting

“…4,5 One key challenge to implementation research is the constantly changing landscape in which interventions are put into practice, thus raising the possibility that observed outcomes may not actually be attributable to the intervention itself. 19,20 …”