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Research suggests that organizational changes can radically alter the informal working lives of middle managers in British firms, particularly if managers are required to introduce change irrespective of their own negative reactions. The psychological contract with middle managers changes in the areas of motivation, ethics, goals, role behaviour and knowledge, with their negative reactions leading to contrariness, uncertainty and 'double-bind,' where they perceive themselves to be in a no-win situation.

The role played by middle managers in both public and private sector organizations in the UK has been radically reshaped by a complex array of economic pressures such as the deregulation of business, rapid technological change and increased international competition. An examination of eight case studies reveals that contrary to popular belief, middle managers have not been made redundant by the structural changes that have transformed the organization of both public and private sector institutions. Instead, the case studies show that middle managers in the private sector wield greater responsibilities, albeit within the framework of a leaner corporate organization. The case studies also indicate that public sector middle managers have also enhanced the scope of their role, though at a more gradual rate, in the increasingly streamlined hierarchy of public sector institutions.

Abstract Background The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and therefore should contribute to the evidence base about an increasingly popular (e.g., Mode two, integrated knowledge transfer, interactive research), but poorly understood approach to knowledge translation. Additionally we hope to develop approaches for evaluating implementation processes and impacts particularly with respect to integrated stakeholder involvement.

Abstract Background The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use. Aim To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities. Design This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.

Organizational scholars increasingly view institutionalization as a process through which actors adapt or translate seemingly successful practices in a field to create variations that are specific to their own organization. Yet little is known about how outsiders who seek to diffuse 'best practice' affect translation. We examined interactions between management consultants and their clients in two different consulting projects, which focused on embedding the practice of 'lean' in one and the practice of a quality improvement framework in the other. Our findings provide insights into the processes of translation through which promoters and adopters iterate at different stages to reach a compromise, illuminating how the evolution of an imported practice signals the outcome of a negotiation. Furthermore, we demonstrate that management practices are not translated in isolation but enveloped by peripheral practices that are adopted by association. We highlight how the peripheral practice of benchmarking, in both cases, was rarely contested or negotiated and thus proved more resistant to translation. Our analysis allows us to unpack the agency inherent within translation‐as‐negotiation and integrate research on diffusion and translation. [ABSTRACT FROM AUTHOR]

Hospitals increasingly adopt standardized policies as a way to improve the efficiency of health care delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long‐term failure costs of the operation for these patient groups. Based on our findings, we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per nonemergency hernia procedure (19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice and discuss the wider theoretical contributions to the wider standardization‐customization debate in health care operations management. [ABSTRACT FROM AUTHOR]

This article reports on a two-year, multi-method, qualitative study in two regional offices in the UK National Health Service of the changing role of the regional tier from the autumn of 1994. The nature of the changes from fourteen semi-autonomous regional health authorities to eight regional offices of the NHS Executive, whose staff became civil servants, are described together with the. way this reorganization changed the role and relationships of NHS Executive HQ, the regional offices and the field. By the end of our research in the autumn of 1996, the change from regional health authority to regional office had gone well in the two regional offices studied; they had become smaller organizations, had established closer working with HQ and believed they had more influence over policy, while retaining good relations with health authorities. Emerging issues from the changes and some of their implications are discussed, particularly the pressures towards greater centralization and the particular forms that these have taken, despite the aim, and in part the achievement, of greater devolution, and the cultural differences between the NHS and the civil service. We conclude by assessing what the future holds for regional offices, in the light of the recent NHS White Paper (Secretary of State for Health 1997)., There is a need for regional offices in the UK's National Health Service. There is a balance between control and complete autonomy with the presence of regional offices and officers. A lack of communication and a lack of organization could also develop if too many layers of command are removed.