The Translational Role of Hybrid Nurse Middle Managers in Implementing Clinical Guidelines: Effect of, and upon, Professional and Managerial Hierarchies

Abstract

Our study uses qualitative and interpretative design to analyse what hybrid nurse middle managers do in their managerial practice, what affects this, and to what effect, focusing upon implementing policy‐driven guidelines on the clinical frontline. Examining two comparative hospital cases and drawing upon Scandinavian institutionalism, we conceive their role as one of ‘translation’. On the one hand, they exhibit strategic agency. On the other hand, their managerial role not only influences, but is influenced by, professional and managerial hierarchies. In both hospitals, in the short term we see how hybrid nurse middle managers are able to mediate professional and managerial hierarchies and implement clinical guidelines through translational work. However, in one case, they less effectively accommodate policy‐driven, managerial pressure towards compliance with government regulations and financial parsimony. In this case, the outcome of their translational work is not sustained in the longer term, as professional and managerial hierarchies reassert themselves. Drawing upon the example of their managerial role in healthcare, we highlight that hybrid middle managers enact a strategic translational role and outline situational constraints that impact this more strategic role.

Sharing leadership for diffusion of innovation in professionalized settings

“…Our empirical analysis suggests, first, variation in financial performance of the hospitals explains less sharing of leadership for diffusion of innovation. This is consistent with extant literature (Currie and Spyridonidis, 2015;Spyridonidis and Currie, 2016). In a situation of financial constraint for example, managers may prove to be preeminent actors, and so stymie the enactment of shared leadership necessary for diffusion of innovation.…”

“…Finally, our study responds to calls for more contextualized understandings of leadership dynamics (Liden and Antonakis, 2009). Our study highlights the effect of organizational financial performance (Currie and Spyridonidis, 2015;Spyridonidis & Currie, 2016), enactment of hybrid leadership (Croft et al, 2015a;2015b), and existence of hierarchical or collaborative organization (Adler et al, 2015;Adler, Kwon and Heckscher, 2008;Heckscher and Adler, 2006;Irvine, 1999;Mitchell and Ream, 2015) upon shared leadership for diffusion of innovation.…”

“…At the same time, another actor (e.g. a middle level leader with a professional background) may act as a linking pin between the strategic apex of the organisation and frontline professionals (Currie and Procter, 2005;Burgess and Currie, 2013;Spyridonidis and Currie, 2016) to ensure professionals buy into the executive leader's vision and strategic objectives as innovation develops. Finally, other actors that have stronger affiliation with professionals on the ground, may facilitate the implementation process by acting as champions of change (Dopson et al, 2002).…”

The state of HRM in the Middle East: Challenges and future research agenda

“…One outcome of the passage of Western MNCs to the region has been the transfer of their HR systems to their Middle Eastern operations (e.g., Dowling, Festing, & Engles, 2013). In this regard, scholars have regularly looked at the challenge of the application and successful transfer of Western MNCs' HR practices in the Middle Eastern context (e.g., Mellahi, Demirbag, Collings, Tatoglu, & Hughes, 2013;Nakhle, 2011;Spyridonidis & Currie, 2016). The patchy evidence emanating from the literature portrays a mixed picture, that is, the strong socio-cultural and institutional context of the region demands foreign firms to adapt their headquarter HR practices to suit the Middle Eastern set-up.…”

Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries

“…The concept of hybridity is a subject that has previously attracted some interest in relation to implementing evidence into nursing practice. For example, an English study examined nurse consultants as a form of hybrid role, proposing that it could combine a strategic translational focus with the ability to influence both professional and managerial hierarchies (43). It may also be useful to consider hybridity at the organisational level.…”