Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review

Abstract

BackgroundMiddle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role.MethodsWe searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge.ResultsOne hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role.ConclusionsOur findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0843-5) contains supplementary material, which is available to authorized users.

Value, knowledge and implementation on evidence‐based practice among nurse managers in china: A regional cross‐sectional survey

“…For example, Powell et al () reported that clinicians in organisations with more proficient cultures or more proactive implementation leadership had greater knowledge of EBP. Birken et al () findings noted that the implementation climate would affect the nurse managers’ role in implementing EBP. In reverse, building EBP implementation climate requires nurse managers to disseminate the significance of EBP and promote EBP practice through the policies and reward systems they established (Aarons et al, ).…”

“…In reverse, building EBP implementation climate requires nurse managers to disseminate the significance of EBP and promote EBP practice through the policies and reward systems they established (Aarons et al, ). Nurse managers play a fundamental role in shaping supportive EBP implementation culture in health care organisations (Birken et al, ). Nurse managers’ attitudes and performance of EBP are related to the EBP implementation climate.…”

“…Warren et al () indicated that managers are the facilitators of EBP as well as the active participants in EBP activities. Nursing managers as the supervisor and organizer of their unit are responsible for providing resources or information, ensuring delivery of health care and shaping EBP implementation climate (Birken et al, ; Shuman et al, ). Based on these responsibilities, managers have unique position to drive the translation of evidence into practice.…”

EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care

“…Previous studies demonstrate critical attributes and behaviors of leaders that influence EBP implementation (Aarons, Ehrhart, Farahnak, & Sklar, ; Birken et al, ; Gifford et al, ). For example, Shuman, Liu, and colleagues () suggest that frontline leaders play a key role in creating practice climates that foster and promote EBP implementation.…”

Nursing staff’s evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study

“…This complexity should be accounted for and attended to in order to facilitate successful implementation, and develop new knowledge and practice. Within this complexity, factors that affect implementation processes include the physical environment and infrastructure, availability of time and resources, availability of staff training, availability of support, receptiveness of organizational culture, involvement of all stakeholders, demonstrable benefits of the change and empowering leadership [34][35][36][37][38][39].…”