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Table 3 Meta-summary of the included studies

From: Healthcare middle managers’ experiences of developing capacity and capability: a systematic review and meta-synthesis

Author, year, country Aim Participants (n = 482)
Data analysis Context Capacity and capability are described as (Results):
1. Bergin (2009)
Sweden [60]
To elucidate processes involved in the way HMMs face and deal with their work situation 10 HMMs (Nurses and physiotherapist)
Individual interviews
Grounded theory
(Glaser [83, 84], Glaser et al. [85], and Kvale [86])
District hospitals and municipal long-term care Experiences of defining their own leadership limits; trusting their own assessments and valuing their own competence and experience; creating space for reflection and learning; generating a managerial identity and integrity, respect for human diversity, and self -respect; establishing authority, autonomy, power, and influence
2. Chuang et al. (2011) USA [61] To understand organizational and relational factors that influence middle managers’ support for innovation implementation processes 92 HMMs (Nurses and environmental
services staff)
Individual interviews and focus groups
Thematic analysis
(Erzberger [87]; Miles et al. [88])
General hospital Experiences of development of complex innovations and improved performance based on early and often information, maximized discretion, resource availability, upper management support and a learning culture
3. Clarke et al. (2012)
Australia [62]
To evaluate the professional development components of the New South Wales Health Take the Lead Program 17 HMMs (Nurses)
Qualitative questionnaires, individual telephone interviews, and focus groups
Standard quantitative methodology
(no ref)
District and general hospitals Experiences of feeling valued and empowered in an increasingly complex healthcare, developing a network, focusing on reflection, being a role model. Less administrative, more frontline leadership. Appreciation of the role and nursing as a profession, time management, concentration, better strategic planning, positive future outlook
4. Cummings et al. (2014)
Canada [63]
To pilot a 2-day coaching workshop conducted as a leadership development strategy 21 HMMs (Nurses)
Workshops and
focus groups
Iterative approach
(no ref)
Municipal long-term care Experiences of increased intentions to be a coach and coaching skills dealing with complexity. Communication techniques, technique of leading by example. Building confidence and empowering staff. Promoting feedback processes. Trust and respect between HMMs and staff
5. Debono et al. (2014)
Australia [64]
To examine the effect of the Take the Lead Program on Nursing Unit Managers’ and Midwife Unit Managers’ job performance, leadership skills and the experiences of their patients 60 HMMs (Nurses and midwifes)
Individual telephone interviews
Thematic analysis
(Creswell et al. [89])
District and general hospitals Experiences of a multifaceted educational program meeting complexity which enhanced job performance, leadership skills and confidence. Some improved patient experiences. Lean thinking and communication were experienced as most valuable. Improvement in problem-solving and decision-making skills. Collaborative articulation as a result of networking
6. Dellve and Wikstrom (2009)
Sweden [82]
To conceptualize how health care leaders may be supported to influence their psychosocial work environment 39 HMMs (Nurses and physicians)
Individual interviews and focus groups
Grounded theory
(Glaser [83], Glaser et al. [85] and Charmaz [90])
District and general hospitals and municipal healthcare Experiences of managing complex workplace stress, socializing in formal and informal leadership strategies, strategic leadership structures and occupational identity. Networking increased dialogue, cooperation and understanding. Reflective dialogue, communication and feedback from top managers, staff and human resources. Strategic mentorship programs and multidisciplinary leader development courses. Theoretical and practical knowledge. Self-reflection. Trust. Teamwork
7. Dellve and Eriksson (2017)
Sweden [65]
To describe the theoretical framework, i.e., the theoretical underpinnings and pedagogical principles, for leadership programs that support managers’ evidence-based knowledge of health-promoting psychosocial work conditions as well as their capability to apply, adapt, and craft sustainable managerial work practices 44 HMMs (Professional background not described)
Individual interviews and focus groups
(no ref)
District hospitals and municipal healthcare Experiences of providing a systematic approach for working with complex issues, knowledge and inspiration, reflective dialog.
Broader perspectives and concrete tools. Support, encouragement and inspiration from peer managers. Relational coordination. Top management support. Following up at one’s own workplace
8. Eide et al. (2016)
Norway [66]
To develop and investigate the feasibility of a 6-week web-based ethical leadership educational program and learn from participants’ experience 9 HMMs (Nurses)
Focus groups
Content analysis
(Elo and Kyngäs [91])
Municipal long-term care, homecare and health centres Experiences of reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change. Ethic projects, situational feedback, mindfulness exercises, I’m ok diary, actualized ethical leadership issues, and improvement proposals
9. Goodridge et al. (2015)
Canada [67]
To address changes in leadership practices associated with the implementation of Lean, and how the changed practice contributes to subsequent outcomes 4 HMMs (Professional background not described)
Workshop, documentary review and individual interviews
A realist coding framework
(no ref)
District and general hospitals and municipal healthcare Experiences of Lean as complex interventions, aligning aims and objectives, attention and resources to quality improvement and change management, tools, changed attitudes or beliefs about leadership, increased levels of expertise, accountability and commitment, measuring and using data effectively, creating or supporting a learning organization culture. Network. Self-confidence. Empowered by autonomy, information, support, resources and professional development
10. Hartviksen et al. (2018) Norway [44] To identify and discuss the facilitation of HMMs’ development of capacity and capability for leadership 16 HMMs (Nurses)
Focus groups
Critical hermeneutic
(Kvale and Brinkmann [81], Alvesson and Sköldberg [92])
General hospital, municipal long-term care and homecare Experiences of trusted interaction despite organizational and structural frames and knowledgeable understanding of complex context, knowledge, trust, and confidence. Transformative learning, coherence, reflection, discussion, repetition, workshops, knowledge sharing, and short lectures. Network. Flexibility. Leadership plan. Changed approach to leadership
11. Hodgson (2015)
Canada [68]
To explore the development of self-efficacy in nursing leaders 7 HMMs (Nurses)
Individual interviews
Content analysis
(Polit and Beck [93])
District and general hospitals Experiences of horizontal mentoring and developing self-efficacy in complex healthcare systems. Confidence, knowledge, feedback, validation and communication. Observing others. Experience of choosing to sink or swim. Human resources. Relationships with others. Knowing who to call. Support from peers and superiors. Individual strategies. Reflection, following the rules and/or learning by mistakes
12. Hyrkäs et al. (2005)
Finland [69]
To explore how first-line managers see future effects of the clinical supervision intervention 1 year after its termination 12 HMMs (Nurses)
Short essays
Thematic analysis
(no ref)
District hospital Experiences of positive long-term effects on leadership, leadership role, interaction and communication skills, the desire for self-development, self-knowledge and coping. A broader perspective on work in a complex context, enhanced use of clinical supervision as a supportive measure. Skills in human resource management
13. Korhonen and Lammin-takanen
Finland [70]
To describe nurse managers’ expectations, attitudes and experiences of web-based learning before and after participation in a web-based course 23 HMMs (Nurses)
Diagnostic assignments and individual interviews
Content analysis
(Cavanagh [94], Insch et al. [95])
District and general hospitals Experiences of changed attitudes to web-based learning. Lack of recourses limited the development. Developed information technology skills. Professional development as a nurse manager, developing oneself, management skills, and written communication and interaction skills
14. Lavoie-Tremblay et al. (2014)
Canada [71]
To describe managers’ and health care providers’ perceptions of the development of their change capacities with the Transforming Care at the Bedside Program in a university-affiliated health care organization 3 HMMs (Nurses)
Focus groups and individual interviews
Guided by the interview questions, using NVivo
(Polit and Beck [93], Miles et al. [88], Miles et al. [96])
District hospital Experiences of understanding the bigger picture, structured process to lead change, learning skills, skills to engage team members, better organize and plan changes, group cohesiveness and belonging, awareness of others, work as a team, new relationships, and to make results visible
15. Lunts (2012)
United Kingdom [72]
To explore what middle managers perceived as helping them in the delivery of change in one high-profile integration project 6 HMMs (Professional background not described)
Individual interviews
Grounded theory
(Corbin and Strauss [97])
Municipal healthcare Experiences of progress, informal networks. Dedicated time and awareness of complexity, leadership models, help to lead change. Clear steering and vision from senior leaders. Clear structures. Trust and respect. Mental models and strategies for working in complexity. Conceptual models and practical guidance on dealing with change within complexity
16. MacPhee et al. (2011)
Canada [73]
To describe nurse leaders’ perspectives of the outcomes of a formal leadership program 27 HMMs (Nurses)
Individual telephone interviews
Content analysis
(Graneheim and Lundman [98])
District and general hospitals, municipal homecare, mental and public health Experiences of increased self-confidence, positive changes in leadership styles, the importance of communication, reflection and discussions in complex health environments. Fulfil their leadership roles and responsibilities. Feedback from senior management. Leadership skills. Mentoring. Adding recourses and tools. Project management competencies. Change management. Workshops. Nursing focus. Interprofessional courses
17. Miltner et al. (2015)
USA [74]
To describe the identified professional development needs of nurse managers in a metropolitan area in the south-eastern United States 20 HMMs (Nurses)
Focus groups
Content analysis
(Hsieh and Shannon [99])
District and general hospitals Experiences of learning as you go and gaining a voice navigating complexity, and to garner support. Internal mentoring programs
18. Paliadelis (2005)
Australia [75]
To explore nurse unit managers’ stories about the education and support they receive in their role 20 HMMs (Nurses)
Individual interviews
Voice-relational method
(Gilligan [100], Mauthner and Doucet [101], Doucet and Mauthner [102])
General hospitals Experiences of a lack of support, individual seeking of suitable sources of management education, peer group support. To sink or swim
19. Paliadelis et al. (2007)
Australia [76]
To explore how nurse unit managers cope, what helps them in their role 20 HMMs (Nurses)
Individual interviews
(No ref)
General hospitals Experiences of lack of formal support and respect in an increasingly complex role, support within own ranks. Sink or swim
20. Simpson (2006)
Canada [77]
To identify the enhancers for informal learning, create and support a culture of learning and innovation 9 managers
(Number of HMMs and professional background not described)
Field work, individual interviews and focus group
Several, interpretivist
(Gubrium and Holstein [103], Miles et al. [88])
District hospital Experiences of informal learning about people, values and culture, knowledge, attitudes and skills. Collaboration, networking and sharing, passion and purpose, trust. Balancing challenges, opportunities and support, learning and creativity, respect. Connection to the organization, empowerment and freedom, modelling, no blame environment, recognition, support and valuing. Conversations and storytelling
21. Tistad et al. (2016)
Sweden [78]
To explore the feasibility and usefulness of a leadership intervention to support managers’ implementation of clinical practice guidelines recommendations, considering the influence of the context 11 HMMs (Professional background not described)
Fieldwork, individual interviews and individual telephone interviews
Content analysis
(Elo and Kyngäs [91], Graneheim and Lundman [98])
Specialized hospitals Experiences of the participation of senior and frontline managers. Both understanding and templates are required to recognize and manage complexity.
Leadership plan, knowledge and skills. Limited impact on managers’ behaviours or clinical practice. Increasing understanding and awareness of their vital role
22. Tyan (2010)
Taiwan [79]
To examine the perspectives of Taiwanese nurse managers who participated in a US home healthcare learning tour regarding the development of home healthcare for the elderly in Taiwan and to describe the views of Taiwanese home healthcare nurse managers on empowerment within the context of home healthcare 5 HMMs (Nurses)
Focus groups, self-reflective diaries, individual interviews, fieldwork, and qualitative questionnaires
Content analysis
(Hsieh and Shannon [99])
District hospitals Experiences of professional development from taking an international learning tour. Based on the complexity of patient care. Experiences of being empowered on the individual and interpersonal level, but powerless on the system level
23. Udod and Care (2012)
Canada [80]
To explore the stress experiences and coping strategies of nurse managers in an acute care setting in Canada to recruit and retain individuals in nurse managers roles 5 HMMs (Nurses)
Individual interviews
Content analysis
(no ref)
District hospital Experiences of less effective coping strategies. A need for infrastructure and support systems. Access to continuous professional development, flexible, respond to rapidly changing complex environment