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Updated: Mar 31, 2026

The Innovation Arena: A Method for Comparing Innovative Problem-Solving Across Groups
Published on: May 13, 2022
What roles do middle managers play in implementation of innovative practices?
Ryann L Engle1, Emily R Lopez, Katelyn E Gormley
1Ryann L. Engle, MPH, is Health Science Specialist and Senior Project Manager, Center for Healthcare Organization and Implementation Research (CHOIR), Department of Veterans Affairs, Boston, Massachusetts. E-mail: ryann.engle@va.gov. Emily R. Lopez, MPH, is Project Coordinator, Department of Enabling Technology, McKesson Specialty Health, The Woodlands, Texas. Katelyn E. Gormley, MPH, is Project Manager, CHOIR, Department of Veterans Affairs, Boston, Massachusetts. Jeffrey A. Chan, BS, is Senior Project Manager, CHOIR, Department of Veterans Affairs, Boston, Massachusetts. Martin P. Charns, DBA, is Co-director, CHOIR, Department of Veterans Affairs, and Professor of Health Policy and Management, Boston University School of Public Health, Massachusetts. Carol VanDeusen Lukas, EdD, is Senior Investigator, CHOIR, Department of Veterans Affairs, and Clinical Associate Professor, Boston University School of Public Health, Massachusetts.
Middle managers are crucial for implementing new hospital practices. Research identified specific strategies, like fostering buy-in, that enhance their effectiveness in driving innovation and organizational change.
Area of Science:
- Healthcare Management
- Organizational Behavior
- Implementation Science
Background:
- Middle managers are vital links between hospital leadership and frontline staff.
- Their role in implementing new practices remains under-researched.
Purpose of the Study:
- To enhance understanding of middle managers' organizational influence.
- To examine middle manager activities using two conceptual frameworks.
Main Methods:
- Qualitative analysis of 98 interviews from 17 Veterans Affairs Medical Centers.
- Data analysis focused on identifying themes related to middle manager activities in change implementation.
Main Results:
- Identified 14 themes of middle manager commitment to innovation implementation.
- Found differences in activities and interactions between high and low organizational change potential sites, though most themes were present in both.
Conclusions:
- Middle managers can employ identified strategies to improve implementation effectiveness.
- These findings can guide senior leaders in supporting middle managers' change initiatives.
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