Where the Rubber Meets the Road: Middle Managers Role in Innovation Implementatio

描述（由申请人提供）：尽管越来越多的证据表明卫生保健组织的临床和管理实践有效，但证据与实践之间存在很大差距。最近的实证研究估计，在质量改进研究中确定的创新的执行率不到50%。关于医疗保健实施有效性的大量文献主要集中在高层管理团队和医生的作用上。中层管理人员在创新实施中发挥着关键但却鲜为人知的作用。摘要本研究旨在探讨医疗机构中层管理人员在创新实施中的角色。理论表明，在提供工作资源的组织中，中层管理人员可能会增加对创新实施的承诺。本研究的第一个目的是利用一项自我调查的二手数据来评估(1)中层管理者创新实施承诺与实施效果之间的关系，(2)工作资源与中层管理者创新实施承诺之间的关系。研究目的二是采用半结构化访谈法，广泛探讨中层管理人员创新实施承诺提高创新实施有效性和工作资源提高中层管理人员创新实施承诺的机制。研究结果将为卫生保健组织确定高杠杆方法，以促进将证据转化为实践，并为越来越多的关于实施有效性的文献做出贡献。

DESCRIPTION (provided by applicant): Despite mounting evidence regarding efficacious clinical and managerial practices in health care organizations, a large gap exists between evidence and practice. Recent empirical studies estimate that the implementation rate of innovations identified in quality improvement research is less than 50 percent. An extensive body of literature on implementation effectiveness in health care has largely focused on the role of top management teams and physicians. Middle managers have a critical yet poorly understood role in innovation implementation. The purpose of this study is to assess middle managers' role in innovation implementation in health care organizations. Theory suggests that middle managers in organizations that provide job resources may reciprocate with increased commitment to innovation implementation. The first aim of the proposed study is to employ secondary data from a self-administered survey to assess the relationship between (1) middle managers' commitment to innovation implementation and implementation effectiveness and (2) job resources and middle managers' commitment to innovation implementation. The second study aim is to employ semi- structured interviews to broadly explore the mechanisms through which (1) middle managers' commitment to innovation implementation increases implementation effectiveness and (2) job resources increase middle managers' commitment to innovation implementation. Study results will identify high-leverage ways for health care organizations to facilitate the translation of evidence into practice and contribute to a growing body of literature on implementation effectiveness. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it will identify high-leverage ways for health care organizations to facilitate the translation of evidence into practice. Implementing innovations has the potential to improve health care quality, access, and costs.