NHS HealthchecksMiddle level managers have a vital role to play as NHS organisations review how they operate in the wake of the Mid-Staffordshire scandal.

That is the view of Professor Graeme Currie after extensive research into the role of middle management found that they play a pivotal role in patient safety at hospitals.

In recent years there has been significant pressure on the NHS to remove middle level managers in an effort to protect frontline services, but far from being dispensable Professor Currie and Warwick Business School colleague Assistant Professor of Operations Management Nicola Burgess’ research found what they term ‘hybrid middle managers’ to be an important cog in hospitals.

“These managers may have different professional backgrounds, are located at different levels of an organisation and carry varying degrees of responsibility,” said Professor Currie. “What they all have in common, though, is the ability to act as a two-way mirror; capable not just of assimilating top-down management knowledge but also of translating and transmitting ideas belonging to clinical practice back up into their organisation.

“Studies into organisational behaviour indicate that these individuals have an almost unrivalled ability to share knowledge within and between healthcare organisations. They operate at the front line of service delivery and enjoy credibility and legitimacy within their clinical communities that is not afforded to more generalist managers.

“There is a common theme running through recent reports into patient safety in the NHS: the failure of organisations to pick up and act upon concerns emanating from the frontline.
“Breaks in the information chain between day-to-day clinical practice and management structures have led to sub-standard services.

“In the wake of scandals such as Mid-Staffordshire, all NHS organisations are currently reviewing how they can use frontline clinical experience to shape their strategic thinking. In doing so, they should focus on the vital role that hybrid middle managers have to play in this process.

“This ability to effectively broker knowledge upwards, downwards and sideways is a hugely valuable commodity. It has the potential to act as the all-important bridge between ward and board. Yet too often in the NHS it is not nurtured and encouraged.”

Professor Currie warned ‘hybrid middle managers’ are increasingly under pressure to comply with bodies and agencies for patient safety rather than putting into practice what they experience on the frontline. And he feels more training around their role as knowledge brokers should be implemented so they develop a good rapport with general management.

“One of the key findings of our research was that in organisations where teams had developed a collective identity, there was effective information sharing that crossed status and inter-disciplinary divides.”