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  • Publication # 14-RA001

Proactive middle managers improve health care innovation effectiveness

Patient Safety and Quality

Implementing health care innovations continues to be challenging. Less than 50 percent of quality improvement initiatives are successfully implemented. Many barriers thwart the implementation of these innovations, such as competing priorities and inertia. Middle managers may play an important role in overcoming these challenges and promoting successful health care innovation implementation, suggests a new study. 

The researchers used information from the Health Disparities Collaboratives (HDC) Survey of 149 community health centers in 21 States. HDCs are designed to improve the management of chronic diseases using the Chronic Care Model. Among those surveyed were 120 HDC team leaders who were considered middle managers; 103 CEOs of the community health centers also responded. 

The researchers found that middle managers' commitment influenced the effectiveness of implementing the HDC. High-commitment middle managers engaged in behaviors outside of their normal roles with a positive attitude that promoted effective implementation.Their proactive "can-do" attitudes made them particularly efficient at developing linkages with community resources. By being able to span organizational boundaries, these middle managers were able to serve as liaisons and to ensure the quality of patient data and reports. They also reported viewing themselves as information brokers. As such, they drew upon a host of information resources to make HDC implementation details relevant to employees. 

High-commitment middle managers were more positive in talking about their creative, effective approaches to addressing barriers. Low-commitment managers, on the other hand, complained about their frustration with barriers to implementing the HDC. The study was supported in part by AHRQ (HS19107). 

See "Improving the effectiveness of health care innovation implementation: Middle managers as change agents," by Sarah A. Birken, Ph.D., Shoou-Yih Daniel Lee, Ph.D., Bryan J. Weiner, Ph.D., and others in the February 2013 Medical Care Research and Review 70(1), pp. 29-45.


Page last reviewed October 2013
Internet Citation: Proactive middle managers improve health care innovation effectiveness: Patient Safety and Quality. October 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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