Middle Managers’ Role in Implementing Innovative Practices in VA: Lessons Learned from the Field

Background: Middle managers play key roles in hospitals as the bridge between senior executives and frontline staff. Yet relatively little research has focused on their role in implementing new practices. Purpose: This study expands the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks. Methodology/Approach: We analyzed qualitative data from 17 VAMCs with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior executives to frontline workers to identify emergent themes reflecting middle-manager activities. Themes were then mapped against an priori framework. Findings: Analyses yielded 14 emergent themes that allowed us to classify 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 ...