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Table 3 Themes representing MM KB roles and activities

From: The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

MM KB Roles Corresponding MM KB activities Illustrative Quote
Gather data • Conduct needs assessments, literature searches
• Obtain and diffuse information
“MMs use innovative electronic tools and visual data in order to convey real-time information to their staff” [46].
Coordinate projects • Coordinate research activities
• Apply for grants and other funding
• Prepare documents, checklists
• Develop tools and algorithms
• Primary and co-investigators in research projects
“They were responsible for associated administrative tasks such as developing recruitment processes and interview schedules” [47].
Monitor and evaluate progress of project • Hold meetings with teams to identify what was working and not
• Monitor unit performance
• Use their clinical expertise and contextual understanding to adapt materials, prioritize QI activities
• Evaluate performance
• Provide thoughtful feedback on performance
• Initiate improvements
“MMs reported back to senior management on implementation progress and issues” [48].
Adjust implementation of project to organizational context • Align with organization strategy, mission, vision, values
• Adapt information to local context
• Use daily conversations to translate the strategic plan
• Integrate changes into other initiatives
“The two strategies used most commonly to adapt change to the organizational context were exploring, auditing, and monitoring best practices, and policy and documentation changes to incorporate guideline recommendations” [49]
Disseminate Information • Present data
• Attend shift report
• Initiate meetings
• Communicate professional updates
• Use visual/verbal reminders
• Facilitate staff access to evidence
“MMs frequent updates and guidance through emails, weekly briefings and attendance at shift handover was crucial” [50].
Facilitate networks • Open doors because of networks
• Engage key informants and knew gatekeepers
• Network
• Make influential people aware of KT issues
• Use social capital to develop relationships
• Locate influential partners
“Manager fellows helped by being on the inside and knowing gatekeepers and key informants and being able to engage them” [39]
Bridge the evidence-to-practice gap • Boundary spanner
• Bridge management’s requirements and patients’ needs
• Link Quality Improvement teams with Senior Management
• Lateral integrator
• Link between researchers and staff
• Link individuals and groups
“Some manager fellows were particularly valued by the research team because they also had specific knowledge or access to professional networks” [39].
Engage Stakeholders • Use strategies to engage staff
• Engage staff in developing and meeting targets
• Facilitate conversations and communication
• Mediate between strategy and day to day activities
• Measure performance and engage in frontline activities
“MMs influence facilitating organizational change may stem from overseeing team activities, mediating between organizational strategy and day-to day activities of staff and helping interpret information in a way that is relevant to each member of the team” [40].
Convince others of the need for, and benefit of a project • Promote and advocate the program
• Be persuasive at all committee levels
• Justify the innovation
• Encourage staff to use those innovations consistently and effectively
• Give rationale for change
• Establish trust and rapport
• Reinforce initiative/expectations
• Hold ongoing conversations team to ensure “everyone was on board”
“The ongoing conversations the unit managers had with the project leads, clinicians, and staff ensured that “everyone was on board” for the local QI efforts. These informal conversations are important as they help clinicians perceive benefits of the improvement, promote collaboration, and emphasize accountability to ensure the successful implementation of local QI efforts” [51].
Coach staff • Coach and mentor individual staff
• Coach and mentor teams
• Develop and educate staff
• Act as a resource to help staff
• Facilitate individual capacity development in evidence-informed decision making
“I love when I am able to interact and mentor my staff, resulting in positive outcomes for the unit. That is when I am more energized and find the most job satisfaction” (Manager Participant) [52].
Provide tools and resources • Provide staff with the tools to implement the innovation
• Provide operational support – resources, tools, training of staff
• Procure organizational resources
• Provide funds for training and supplies
• Find creative ways to overcome barriers
“Managers tried to provide flexibility in schedules to ensure that clinicians, predominately nurses, had sufficient time and space to manage clinical and QI work” [51]
Function as strategic influencer • Accountable 24/7 for their care areas and patient safety
• Responsible for large number of employees and regulatory compliance
• Lead teams
• Members of decision-making groups for strategic planning
• Authoritative contact for initiatives
“MMs can capitalize on their unique position between upper and lower levels in the organization and engage in ambidextrous learning that is critical to implementing and sustaining radical change” [53].