The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

Boutcher, Faith; Berta, Whitney; Urquhart, Robin; Gagliardi, Anna R.

doi:10.1186/s12913-021-07387-z

Cited by 13 publications

(12 citation statements)

References 101 publications

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“…Managerial support of research and the proximity with the clinical team, as well the quick access to the researchers may facilitate the CRC’s work in KT activities. This is consistent with the findings regarding KBs’ commitment to the implementation of an evidence-based practice and in optimizing impact on clinical practice [ 69 ]. Factors like time and the availability of resources are both barriers and facilitators.…”

Section: Discussionsupporting

confidence: 91%

Clinical research coordinators’ role in knowledge translation activities in rehabilitation: a mixed methods study

Talla

Robillard

Ahmed

et al. 2023

BMC Health Serv Res

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Background Clinical research coordinators (CRCs) facilitate the interaction between researchers and knowledge users in rehabilitation centres to promote and sustain evidence-informed practices. Despite their presence in rehabilitation settings in Quebec for over 20 years, little is known about their profiles and knowledge translation (KT) activities nor how they can best enact their role. This study explored CRCs’ roles and perspectives on the barriers, enablers, and strategies for improving KT activities in rehabilitation settings. Methods We conducted a multi-centre, participatory sequential mixed methods study. In the descriptive quantitative phase, we collected data via an online survey to determine CRCs’ role in research and KT. In the subsequent qualitative phase, we conducted an in-person focus group to elicit CRCs’ perspectives regarding factors influencing their work in KT, and potential solutions for overcoming these challenges. We used a descriptive and an inductive content analysis approach for the data analysis. The data synthesis was inspired by the Promoting Action on Research Implementation in Health Services framework. Results All nine CRCs from five partner health regions of a large rehabilitation research centre agreed to participate in the study. The data suggest that CRCs are like knowledge brokers and boundary spanners. As information managers, linkage agents and facilitators, CRCs play a pivot role in diffusion, dissemination, synthesis and tailoring of knowledge to improve evidence informed practices and quality of care in rehabilitation. The factors influencing CRCs’ KT activities are mostly linked to the context such as the receptivity of the organization as well as the lack of time and resources, and limited understanding of their roles by stakeholders. Two main suggestions made to enhance CRCs’ contribution to KT activities include the harmonisation of expectations between the large research centre and their partner health regions, and better promotion of their role to clinical and research teams. Conclusions This study provides valuable insights into the scope of CRCs’ role. The results shed light on the challenges that they face and potential solutions to overcome them. The knowledge generated in this study can be used to implement this role with similar duties in rehabilitation settings or other health care domains.

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Section: Discussionsupporting

confidence: 91%

Clinical research coordinators’ role in knowledge translation activities in rehabilitation: a mixed methods study

Talla

Robillard

Ahmed

et al. 2023

BMC Health Serv Res

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“…Weiner BJ pointed out that organizational structures and resources shape readiness for behavior change, and it provided a more acceptable environment for organized employees [ 31 , 34 ]. And organizational resources are dominated by top management support [ 51 , 52 ], in the context of this study, which may influence attitudes and intentions of physicians’ use behavior. Similarly, Qureshi QA pointed out that top management support had a profound impact on subjective norms and individual use behaviors [ 53 ].…”

Section: Methodsmentioning

confidence: 99%

Influencing mechanism of the use behavior of clinical practice guidelines on antimicrobials: evidence from the integration of theory of reasoned action and organizational readiness for change

Huang

Liu

Huang

2022

BMC Med Inform Decis Mak

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Background To confront the serious challenge of antimicrobial resistance, using clinical practice guidelines (CPGs) standardizing the prescription behavior is vital. However, the overall mechanisms remains largely unknown as to how guidelines' use behavior can be improved. This study aimed to identify the determinants and investigate their relationship to bridge the knowledge gap of overall influencing mechanism of the use behavior of CPGs on antimicrobials. Methods By integrating theory of reasoned action (TRA) and organizational readiness for change (ORC), a structured questionnaire was developed to cover potential determinants that affect physicians’ use behaviors of CPGs on antimicrobials at the individual-level (attitude, subjective norm, and behavioral intention) and organizational-level (top management support and organizational resource allocation). A multi-stage random sampling was implemented to collect data from physicians in secondary and tertiary hospitals from eastern, central and western China. Structural equation model (SEM) was used to test the proposed hypotheses, and to analyze the relationship and mechanism among the factors. Result In total, 815 physicians were included. Most physicians demonstrated a positive tendency toward the use of CPGs on antimicrobials, with a mean score of 3.95 (SD = 0.70). The reliability and validity analysis showed the questionnaire constructed from the integrated theoretical model of TRA and ORC was acceptable. The SEM validation results also showed that the top management support (β = 0.688, P < 0.001), organizational resource allocation (β = 0.129, P < 0.001), individual attitudes (β = 0.164, P < 0.001), subjective norms (β = 0.322, P < 0.001), and behavioral intentions (β = 0.424, P < 0.001) were positively associated with physicians’ use behaviors of CPGs on antimicrobials. Besides, top management support, organizational resource allocation, attitudes and subjective norms showed their mediating effects on regarding use behavior, which was 0.305, 0.129, 0.164 and 0.201, respectively. Conclusions This study revealed the influence mechanism of the use of CPGs on antimicrobials from the individual and organizational perspectives. These findings will not only help formulate future strategies to promote the use of CPGs on antimicrobials, but also provide clues for more effective prescription interventions.

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“…Current research suggests that MMs, because of their mid-level positions, may play a key role as internal KBs in facilitating the integration of new knowledge in hospitals to improve quality of care, as well as enhance patients' and families' safety, experience, and outcomes. (Birken et al, 2018;Boutcher et al, 2022). It has been proposed that MMs are well positioned to support knowledge sharing and learning because they are able to participate in multiple communities through their dual directed relationships.…”

Section: Backg Rou N Dmentioning

confidence: 99%

A qualitative descriptive study of the role of nurse, allied health and physician middle managers who function as knowledge brokers in hospitals

Boutcher

Berta

Urquhart

et al. 2022

Worldviews Ev Based Nurs

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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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The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

Cited by 13 publications

References 101 publications

Clinical research coordinators’ role in knowledge translation activities in rehabilitation: a mixed methods study

Clinical research coordinators’ role in knowledge translation activities in rehabilitation: a mixed methods study

Influencing mechanism of the use behavior of clinical practice guidelines on antimicrobials: evidence from the integration of theory of reasoned action and organizational readiness for change

A qualitative descriptive study of the role of nurse, allied health and physician middle managers who function as knowledge brokers in hospitals

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