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Concept: Middle management


Stress in the work place has a detrimental effect on people’s health. Sufficient recovery is necessary to counteract severe chronic negative load reactions. Previous research has shown that vacationing for at least seven consecutive days provided an efficient recovery strategy. Yet, thus far, the effects of short vacations and the mode of vacation (whether at home or in a new environment) have rarely been studied. We investigated the immediate and long-term effects of a short vacation (four nights) on well-being and perceived stress and whether the mode of vacation impacted on these results. Data was obtained from 40 middle managers (67.5% men and 32.5% women). The intervention group (n = 20) spent a short vacation in a hotel outside their usual environment. The control group (n = 20) spent their vacation at home. Results indicated that one single short-term vacation, independent of the mode, has large, positive and immediate effects on perceived stress, recovery, strain, and well-being. Strain levels decreased to a greater extent in the intervention group compared to the control group. The effects can still be detected at 30 days (recovery) and 45 days (well-being and strain) post-vacation. Encouraging middle management employees to take short vacations seems to be an efficient health promotion strategy; environmental effects seem to play a minor role.

Concepts: Environment, Effect, Randomized controlled trial, Effectiveness, Management, Control, Necessary and sufficient condition, Middle management


In response to the call for empirical evidence of a connection between leading and lagging indicators of occupational health and safety (OHS), the first aim of the current research is to consider the association between leading and lagging indicators of OHS. Our second aim is to investigate the moderating effect of safety leadership on the association between leading and lagging indicators. Data were collected from 3578 employees nested within 66 workplaces. Multi-level modelling was used to test the two hypotheses. The results confirm an association between leading and lagging indicators of OHS as well as the moderating impact of middle management safety leadership on the direct association. The association between leading and lagging indicators provides OHS practitioners with useful information to substantiate efforts within organisations to move away from a traditional focus on lagging indicators towards a preventative focus on leading indicators. The research also highlights the important role played by middle managers and the value of OHS leadership development and investment at the middle management level.

Concepts: Economics, Management, Empiricism, Leadership, Occupational safety and health, Leadership development, Middle management, Lagging indicator


Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between “organizing work” and “caring work” is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both “hands-on” and “heads-on” caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate “doings” of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.

Concepts: Patient, Hospital, Management, Contributions, Organizing, Middle management


Demographic changes increase the financing needs of all social services. This change also generates new and complex demands on the medical staff. Accordingly, medical professionals in middle management positions hold a characteristic sandwich position between top management and the operational core. This sandwich position often constitutes new challenges. In the industrial field, the growing importance of the middle management for the company’s success has already been recognized. Accordingly, the growing demand on economy urges an analysis for the medical field.

Concepts: Sociology, Management, Field, Complex number, Polynomial, Characteristic, Middle management, Ordered field


Purpose The purpose of this paper is to report on the validation of a management competency assessment tool for health services managers (HSM), which resulted from the development and validation of the framework, addressed by a previous paper. Design/methodology/approach The management competency assessment tool (MCAP Tool) was validated using assessment data from a sample of 117 senior and middle managers working in two public hospitals and five community services in Victoria, Australia. The assessments were conducted between January 2013 and September 2014. Findings Both validity and reliability of the MCAP Tool were demonstrated. Practical implications The MCAP Tool has the potential to assist in the measurement of the competencies of HSM. Further research is required to determine if the framework and tool are applicable to HSM in other settings. Originality/value This is the first published study outlining the validity and reliability of an assessment tool to measure the management competencies of Australian health service managers.

Concepts: Health care, Medicine, Public health, Health insurance, Health, Psychometrics, Middle management


The trend of promoting clinical experts into management roles continues. New middle managers need a transitional plan that includes support, mentoring, and direction from senior leaders, including the chief nursing officer (CNO). This case study demonstrates how the CNO of one organization collaborated with a faculty member colleague to develop and implement a yearlong personalized on-boarding program for a group of new nurse middle managers.

Concepts: Management, Nursing, Leadership, College, Nurse, Florence Nightingale, Organizational studies and human resource management, Middle management


The overall aim of the investigation was to redress a knowledge gap by exploring community nursing middle managers' (CNMMs') experiences of role enactment through change within Community Health Partnerships (CHPs) in Scotland-now further evolved into Health and Social Care Partnerships (HSCPs). HSCPs play a key role in shifting care from the acute to the primary care/community setting. However, a literature review demonstrated there has been very little research into the role of CNMMs within the changing primary care context. This concept was considered important in understanding how CNMMs enacted their roles to implement service change. A qualitative longitudinal interpretative phenomenological analysis (IPA) ( Smith, 1996 ) study was conducted in four distinct phases, comprising the reflexive, foundational, recursive and expansive, from 2008-2011. Some 35 semi-structured interviews were conducted with 26 participants. CNMMs perceived that their responsibilities had increased, become more complex and wider ranging. Maintaining an implicit connection with service users was a primary motivation for CNMMs. They were proud to be members of the nursing profession aligning their identity with their career history. A small but significant proportion resigned during the study and some were considering leaving the NHS. The study addresses a gap in literature, contributes to the understanding of NHS community nursing, middle management, role, change and gives a voice to CNMMs in Scotland. They are the lynchpins in taking change forward and maintaining quality services. Much more attention needs to be paid to the needs, constitution and sustenance of middle managers in Scottish community nursing-which has policy, practice, education, and research and retention implications.

Concepts: Management, Interpretative phenomenological analysis, Change, Nursing, Motivation, Social sciences, Time zone, Middle management


Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers.

Concepts: Health care, Health economics, Medicine, Health, Management, Health care system, Primary health care, Middle management


Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management’s perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. The aim of this study was to assess middle managers' behaviors to enforce a new national smoke-free hospital campus ban, to evaluate their perceptions of the level of compliance of the new regulation, and to explore their attitudes towards how smoking affects the work environment.

Concepts: Health economics, Health insurance, Clinical trial, Management, Control, State, Massachusetts, Middle management


The aim was to investigate structural empowerment in nurse leaders in middle management positions. (1)To determine levels of empowerment of nurse leaders and (2) to compare levels of empowerment between nurse leader groups (unit leaders and senior staff nurses).

Concepts: Sociology, Management, Strategic management, Nursing, Leadership, Nurse, Organizational studies and human resource management, Middle management