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是有效的，但证据和实践之间存在着巨大的差距。最近的实证研究估计，质量改进研究中确定的创新的实施率不到50%。关于卫生保健实施有效性的大量文献主要集中在最高管理团队和医生的作用上。中层管理人员在创新实施中扮演着关键但却鲜为人知的角色。本研究的目的是评估中层管理人员在卫生保健组织创新实施中的作用。理论表明，提供工作资源的组织的中层管理人员可能会通过增加对创新实施的承诺来回报。本研究的第一个目的是使用来自自我管理的调查的二手数据来评估(1)中层管理人员对创新实施的承诺与实施效果之间的关系，以及(2)工作资源与中层管理人员对创新实施的承诺之间的关系。第二项研究的目的是使用半结构访谈的方法，广泛探索(1)中层管理人员对创新实施的承诺提高实施有效性的机制，(2)工作资源增加中层管理人员对创新实施的承诺的机制。研究结果将确定卫生保健组织促进将证据转化为实践的高杠杆方法，并有助于越来越多关于执行有效性的文献。 公共卫生相关性：拟议的研究与公共卫生相关，因为它将确定卫生保健组织促进将证据转化为实践的高杠杆方法。实施创新有可能改善医疗保健质量、获取途径和成本。

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.