This article examines the role of middle management in facilitating or hindering the implementation of complex changes in health care organizations. While research has affirmed the importance of middle management support in the execution of new initiatives, little is known about which factors influence middle managers’ support of significant reforms.
The authors conducted semi-structured interviews and focus groups with 92 middle managers from 19 health care organizations in the Jobs to Careers: Transforming the Front Lines of Health Care Program. They then coded and analyzed the results of these interviews and focus groups.
- Middle managers were most likely to support the implementation of complex workforce changes when the changes matched the needs and priorities of individual departments or units. Most middle managers felt that the changes would improve teamwork, job satisfaction and quality of care.
- Middle managers who opposed the initiative voiced concerns that the program would hurt the performance of their units, even though they believed that the initiative could benefit the larger organizations.
This research suggests that health care organizations implementing major new initiatives may receive more support from middle managers when the initiatives are aligned with the goals of individual departments and when middle managers have control over the implementation of change within their units.