Embedding organisational quality improvement through middle manager ownership

Area of Science:

• Healthcare Management
• Organizational Psychology
• Quality Improvement Science

Background:

• The critical role of middle managers in organizational change, particularly in quality improvement (QI) initiatives, is widely theorized.
• Empirical research specifically defining and strengthening this role in QI programs remains limited.
• Hospitals require effective strategies to enhance middle manager engagement for sustained QI implementation.

Purpose of the Study:

• To develop and implement a model for strengthening the middle manager role within a hospital's QI program.
• To increase and sustain the organization-wide implementation of QI initiatives.
• To investigate the impact of an enhanced middle manager role on QI program outcomes.

Main Methods:

• A case study-based action research project was conducted in an Australian metropolitan specialist teaching hospital.
• Quantitative and qualitative data were collected pre- and post-intervention.
• A 12-month intervention focused on implementing a model to enhance the middle manager role in QI.

Main Results:

• Significant increases were observed in middle managers' understanding of and ownership towards the QI program.
• Organizational QI implementation levels showed a notable increase.
• Middle managers reported a decrease in their perceived enjoyment of QI involvement despite increased engagement.

Conclusions:

• The developed QI implementation model positively influences middle manager attitudes and involvement, leading to increased organizational QI implementation.
• Findings suggest that while middle manager engagement can be enhanced, their subjective experience of enjoyment may decrease.
• The study provides actionable insights and a framework adaptable to different healthcare settings for strengthening the middle manager's role in QI.