Email updates

Keep up to date with the latest news and content from Implementation Science and BioMed Central.

Journal App

google play app store
Open Access Highly Accessed Open Badges Debate

Uncovering middle managers' role in healthcare innovation implementation

Sarah A Birken1*, Shoou-Yih Daniel Lee2 and Bryan J Weiner3

Author Affiliations

1 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill 1107-A McGavran-Greenberg Campus Box 7411 Chapel Hill, NC 27599-7411, USA

2 Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, Michigan 48109-2029, USA

3 Department of Health Policy and Management, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill 27599-7411, USA

For all author emails, please log on.

Implementation Science 2012, 7:28  doi:10.1186/1748-5908-7-28

Published: 3 April 2012



Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations.


Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation.


Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

Middle managers; Healthcare; Innovation implementation