The Translational Role of Hybrid Nurse Middle Managers in Implementing Clinical Guidelines: Effect of, and upon, Professional and Managerial Hierarchies
| Author | Dimitrios Spyridonidis,Graeme Currie |
| Date | 01 October 2016 |
| Published date | 01 October 2016 |
| DOI | http://doi.org/10.1111/1467-8551.12164 |
British Journal of Management, Vol. 27, 760–777 (2016)
DOI: 10.1111/1467-8551.12164
The Translational Role of Hybrid Nurse
Middle Managers in Implementing Clinical
Guidelines: Eect of, and upon, Professional
and Managerial Hierarchies
Dimitrios Spyridonidis and Graeme Currie1
Henley Business School, University of Reading, and 1Warwick Business School, University of Warwick, UK
Corresponding author email: Dimitrios.spyridonidis@henley.ac.uk
Our study uses qualitative and interpretative design to analyse what hybrid nurse middle
managers do in their managerial practice, what aects this, and to what eect, focus-
ing upon implementing policy-driven guidelines on the clinical frontline. Examining two
comparative hospital cases and drawingupon 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 mid-
dle managers are able to mediate professional and managerial hierarchiesand implement
clinical guidelines through translational work. However, in one case, they less eectively
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. Drawingupon 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.
Introduction
Globally, healthcare organizations have been ex-
posed to public policy reforms, moving them to-
wards more ‘managerialist’ structures (O’Reilly
and Reed, 2010). In countries susceptible to
Anglo-Saxon influence, these policy reforms are
aggregated under the rubric of ‘new public man-
agement’ (NPM) (Hood, 1991). NPM reforms in-
volve a number of overlapping concepts, broadly
Graeme Currie’s time on this studyis supported by fund-
ing from NIHR for ‘Collaboration for Leadership in
Health Research and Care West Midlands (CLAHRC
WM)’. The views expressed in this study are those of
Graeme Currie and his co-author, not those of NIHR.
The authors are grateful to Professor Budhwar and three
anonymous referees for their most valuable comments
and suggestions on an earlier version of the manuscript.
encompassing the need to cut costs and improve
quality through managerial, rather than profes-
sional, power (Diefenbach, 2009). Despite fre-
quent attempts at organizationalchange, however,
professionals are often seen as resistant to NPM
reforms, viewing generalist managerial structures
with distrust or suspicion (Ahmad and Broussine,
2003). Such professional resistance to managerial-
ism, and an enduring commitment to professional
identities and cultures, has led to an increased fo-
cus by policy makers on the need for hybrid mid-
dle managers (HMMs), who combine managerial
and professional responsibilities (Llewellyn,2001),
with growing evidence of their pivotalrole in man-
aging and organizing contemporary healthcare
(Dickinson et al., 2013). Policy co-opts profession-
als into HMM roles to bridge a policy implementa-
tion gap, with the expectationthat HMMs manage
© 2016 British Academy of Management. Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4
2DQ, UK and 350 Main Street, Malden, MA, 02148, USA.
Translational Role of Hybrid Nurse Middle Managers 761
their professional peers (McGivern et al., 2015).
Given this continuing focus upon their ranks to
bridge a policy implementation gap, the time ap-
pears ripe to examine the strategic role of HMMs
and develop a more grounded analysis of what
HMMs actually do in practice.
The extant literature tends to consider HMMs
as responding to new role demands through two
dichotomous responses – a representative role,
buering their peers from managerial intrusion,
or going over to the ‘dark side’ of management
and acting in the strategic organizational interest.
At best, the literature may present a mixed re-
sponse between these extremes (Croft, Currie and
Lockett, 2015). Regarding hybrids as translators
allows for a fuller consideration of a range of
responses that is more nuanced, and highlights
not just their response but what they actuallydo in
practice, around which literature is sorely lacking.
Empirically, to make our contribution, we
examine the day-to-day practiceof HMMs as they
engage in strategic change in the English National
Health Service (NHS). Within this context, as
well as making a more generic contribution
to understanding middle managers’ roles, our
study responds to a specific call for fine-grained
research on the strategic role of middle managers
in healthcare organizations by rendering visible
the strategic work they undertake in their prac-
tice (Walshe and Smith, 2011). We focus upon
implementation of nationally produced clinical
guidelines as exemplars for the study of the role
of HMMs as translators. We discuss later the
notion of HMMs as translators, with a focus upon
healthcare. Before that, we detail our theoretical
approach to translation.
HMMs and translation
To examine HMMs’ managerial practice, we draw
upon the notion of ‘translation’ that focuses on
the role of agency and structure in the social con-
struction of meaning and order (Czarniawska and
Joerges, 1996). We draw upon the Scandinavian
institutionalist notion of translation (Djelic and
Sahlin-Andersson, 2006) that is an alternative
to the diusion models developed by American
institutionalists. The focusof translation literature
is upon the situated nature of institutionalization
(Kraatz and Block, 2008) and practice variation
(Lounsbury, 2008). It signifies a departure from
institutional theory’s initial focus on isomorphism
in organizational fields (Kirkpatrick et al., 2013).
Translation oers a valid ‘explanation’ for the ob-
vious inconsistency between the perceived trends
for organizations to adopt the same dominant set
of managerial ideas from their institutional sur-
roundings but enact them in a dissimilar fashion
(Boxenbaum and Pedersen, 2009).
Middle managers’ translational workduring or-
ganizational change has received significant study
over the years. Studies that invoke a translational
role for middle managers investigate how middle
managers acquire knowledge(Mantere, 2008; Raes
et al., 2011); how they actively engage in using
editing rules to legitimize their translational role
(Balogun and Johnson, 2004); and what they do
to enrol actors to work on the translation of the
new idea (Wooldridge, Schmid and Floyd, 2008)
and sell their own version of how the new idea
should be translated in the organization (Currie
and Procter, 2005; Dutton and Ashford, 1993).
Studies havealso taken a more practice-based view
of their translation to consider how middle man-
agers perform editing rules to translate ideas on
the ground (Teulier and Rouleau, 2013). Aligned
with this, our study examines middle managers’
translation of new ideas on the ground to fullyun-
derstand their translational role with a focus upon
situational constraints that frame this. In focusing
upon situational constraints, we explore what hy-
brid nurse middle managers do in practice, what
aects this and to what eect.
HMMs and translation in healthcare
organizations
Within healthcare, ‘hybrid’ refers to middle man-
agers who are skilled in an alternative occupation
(Llewellyn, 2001). On the basis that there are now
both people and organizational tasks which cross
clinical practices and management boundaries,
management is no longer about ‘oiling the wheels’
(Harrison and Pollitt, 1994). Instead, management
represents an organizational arena where dicult
and contentious clinical management decisions
need to be made, a process in which HMMs have
a key role, since they are particularly concerned
with service improvement and have a zeal for
change (FitzGerald and Ferlie, 2000).
The potential strength of HMMs as translators
comes from their ability to view organizational
issues through ‘two-way windows’ (Llewellyn,
© 2016 British Academy of Management.
To continue reading
Request your trial