Ashley-Kay Fryer, PhD, is Director of Strategy, Optum Analytics, Boston, Massachusetts. E-mail:
Health Care Manage Rev. 2018 Jul/Sep;43(3):218-228. doi: 10.1097/HMR.0000000000000174.
Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success.
We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment.
We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success.
Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success.
We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program.
Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.
最近的文献表明，中层管理者对改进计划的情感承诺（情感依附、认同和投入）可能会影响实施的成功。然而，对于中层管理者情感承诺与一线员工承诺之间的相互作用，即另一个影响实施成功的重要因素，人们知之甚少。
我们通过调查直接管理护理单元一线员工的中层管理者，为这一研究做出了贡献。我们评估了中层管理者的情感承诺与其对实施成功的看法之间的关系，以及他们对一线员工支持的看法是否在这种关系中起中介作用。我们还测试了一组组织支持因素是否能促进中层管理者的情感承诺。
我们根据医院的研究背景，对管理者情感承诺的调查措施进行了调整。我们对来自美国 19 家医院的 67 名护士长进行了调查。我们使用分层线性回归来评估中层管理者对其所在单位减少跌倒项目的情感承诺与其对与该项目相关的三个构念（一线员工支持、组织支持和实施成功）的看法之间的关系。
中层管理者对其所在单位减少跌倒项目的情感承诺与其对实施成功的看法呈正相关。这种关系是由他们对一线员工对跌倒项目的支持的看法所中介的。此外，中层管理者对其所在单位跌倒项目的情感承诺也调节了对项目的组织支持与对实施成功的看法之间的关系。
通过这项研究，我们提供了一个重要的贡献，即提供了可能影响改进计划成功实施的因素的实证支持：中层管理者对改进计划的情感承诺、一线员工对项目的支持和组织对改进计划的支持。
增加中层管理者对改进计划的情感承诺程度，通过促进一线员工对项目的支持，可能会加强项目的实施成功。此外，提供我们调查结构中的组织支持项目可能会增强中层管理者的情感承诺。
