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Senior executives in healthcare organizations increasingly display preference for a closer handling of operational levels, bypassing middle managers, and de-emphasizing the need to cultivate the next cadre of leaders, creating the potential for leadership and performance gaps. The authors argue that middle managers are a vital resource for healthcare organizations and review the benefits for including them in leadership development and succession planning programs. The paper aims to discuss these issues.

Current theories and common practices in addition to data collected from government sources (e.g. BLS), business and industry surveys and reports (e.g. Moody’s, Witt/Kieffer, Deloitte, American Hospital Association) are used to classify the roles, skills, and strategic value of middle managers in healthcare organizations.

The combination of a greater executive span with less hierarchical depth creates a dual effect of devaluing middle management, and a decrease in middle managers’ autonomy. Healthcare middle managers who stay away or lay low further trigger perceptions of low expectations leading to low morale and high levels of stress. Others become hypereffective or develop exit strategies. Major problems are: rising turnover costs; and insufficient attention to succession planning, internal promotion, and leadership development.

The outcomes of this study are useful for management development, particularly at times of change. Practitioners and researchers can have a better understanding of the value of middle managers and their development needs as well as the factors and dynamics that can influence their motivation and affect retention.

Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies can lead to a drastic change in the current perceptions of the importance of middle managers and should lead to long-term retention, well-being, and extrinsic benefits for both the company and its employees.

The aim of this paper is to analyse how technological innovations in performance measurement systems make it possible to overcome some of the challenges that public healthcare organizations face where management and control are concerned. The changes that could be applied to the performance measurement system of healthcare organisations were analysed together with an evaluation of the responses developed in order to achieve these changes.

The paper contains an in-depth case-study of a public university hospital which utilises an innovative information system.

The case-study highlights how technological innovations in performance measurement systems impact the management and monitoring information system in a public university hospital, through the implementation of a multidimensional management dashboard.

The limitation of this paper is that only one case-study is analysed, albeit in depth, while it would be interesting to consider more public university hospitals.

The paper highlights the fundamental role of middle management in change processes in the healthcare sector.

The case-study highlights how critical the active involvement of middle management is in performance measurement and management, and how this is achieved thanks to the adoption of a simple, clear method which ensures comprehensible communication of the objectives, as well as the measurement of performance by means of radar plots.

The purpose of this paper is to explore the incidence of “extreme jobs” among middle managers in acute hospitals, and to identify individual and organizational implications.

The paper is based on interviews and focus groups with managers at six hospitals, a “proof of concept” pilot with an operations management team, and a survey administered at five hospitals.

Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, “24/7 availability”, mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs.

This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices.

A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected.

As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.

This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies.

This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context.

The combination of a greater executive span with less hierarchical depth creates a dual effect of devaluing middle management, and a decrease in middle managers’ autonomy. Healthcare middle managers who stay away or lay low further trigger perceptions of low expectations leading to low morale and high levels of stress. Others become hypereffective or develop exit strategies. Major problems are rising turnover costs; and insufficient attention to succession planning, internal promotion, and leadership development.

The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes.

A mixed-method approach incorporating the Webropol survey was used.

LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN.

This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

The purpose of this paper is to describe how Finnish experts perceive future (year 2030) hospital management and leadership.

A total of 33 experts participated in a three-round Argument Delphi process. Opposing views of management and leadership in 2030 were analyzed using inductive content analysis.

The experts’ perceptions were divided into two main categories: management and leadership orientation and future organization. Perceptions relating to management and leadership orientation were classified as relating to patient-centred, clinical dominance, professionally divided and management career options. Perceptions relating to future management and leadership organization were classified as representing shared, pair, team and the individual-centered leadership. The results highlighted the most distinctive issues raised by the participants.

This qualitative study was conducted in the context of Finnish healthcare according to the principles of the Argument Delphi Method. The panel consisted of high-level experts representing a diverse set of roles. However, as suggested in previous literature, these experts may not be the most astute in predicting the future development of hospital organizations.

The findings can be used to develop and renew management and leadership training and management practices in hospitals.

The findings can be exploited in discussions, planning and decision making regarding future management and leadership in hospitals.

Only a few studies have investigated perceptions of future management in hospitals. This study adopted the Argument Delphi Method to identify distinct perceptions on the future orientation and organization of management and leadership in hospitals.

Previous research has identified associations between quality management and employee health. This study's purpose was to (1) examine those associations in a public healthcare organisation and (2) explore and describe the association between digitalisation and employee health.

An online questionnaire including indices to measure quality management values, employee health and digitalisation was answered by 118 managers in Swedish public healthcare. Correlation analysis was used to analyse the data. Based on the survey results, 12 qualitative, in-depth interviews were conducted with healthcare managers.

The findings show that employee health is associated with quality management and digitalisation. Categories were defined to describe the managers' views of the relationship between digitalisation and health.

Causality was not explicitly tested and cannot be assumed. However, the results strengthen the body of research showing that quality management is related to employee health, and associations between health and digitalisation were identified.

The findings and model should be helpful for healthcare managers in a digitalising environment who aim to preserve or enhance employee health whilst ensuring high service quality.

The results were used to create an integrated conceptual model depicting the association between quality, digitalisation and health. This association has not previously been studied.

The purpose of this paper is to identify social and organizational antecedents of stress. This paper also investigates whether attitudes toward organizational changes and reforms might explain stress perception (SP) and mediate the relationships between social and organizational job characteristics and SP.

A quantitative approach is used to identify the relationships between the research variables. The investigated population is composed of middle managers working in Swiss public hospitals (n=720), which are currently being confronted by major reforms.

The findings show that perceived social support (work relationships with and support from colleagues), as well as several job characteristics (autonomy in performing tasks, flexibility in the organization of working time, degree of conflict) are significantly related to SP. Moreover, positive attitudes toward change are negatively related to stress, and mediate the relationships between perceived social support as well as job characteristics and SP.

This paper sheds light on several job characteristics which could contribute to mitigating SP among middle managers. The findings could therefore guide HRM specialists in their efforts to create a favorable work environment so as to facilitate middle managers’ activities.

The innovation of this paper is grounded in the specific population the author investigate, as the empirical inquiry concerns middle managers working in public hospitals. Moreover, this research highlights the central role of job characteristics and attitudes toward change in explaining SP.

The purpose of this paper is to identify the operational and management challenges in a globally budgeted, regionalized healthcare system and their implications for public service.

Concentrating on British Columbia’s regional health authorities (RHAs) and hospitals, this study utilized data from interviews of key informants, documents (histories, legislation, agreements between RHAs and provincial government, and RHA organizational charts), news reports, and participant observation at board meetings.

Challenges encountered by the managers include accommodating powerful stakeholders (elected officials, providers, and organized publics), adhering to fixed budgets, obtaining capital from public sources, and adjusting to government turnover. In response, the managers engage in balancing priorities of stakeholders, shifting of resources within and across sites and operating units, and working strategically with the capital allocation process. Responses of managers to these challenges have promoted stability but raise concerns about attaining the system’s goals.

Management challenges and potential patterns of response should be considered in assessing the options for health system reforms. Many countries periodically reorganize their healthcare systems, and recognition of potential management challenges can contribute to the achievement of objectives sought in these reforms.

Although studies have demonstrated that management affects the implementation of public programs in several areas, little research has focused on the relationships between features of health systems, management responses, and potential outcomes.

The purpose of this research is to provide an overview of the management skills and competencies required by a director of social work as they perform their multiple roles and functions in order to effectively manage a medical social work team to better serve the needs of patients through the new hospital‐based case management model.

This is a conceptual paper that reviews the literature on managerial roles, management functions, and skills and competencies of directors of social work. Management frameworks that are applicable under the case management model are discussed. Interviews with five directors of social work and their perceptions are described.

Managing a department that is going through continuous changes is often difficult.

This paper has practical implications for general health care managers and specifically, directors of social work, to develop skills and gain competencies to be successful in today's evolving health care environment. This research also has practical implications for social workers to gain insight into productive and effective ways to collaborate with members of an interdisciplinary team.

This paper is original and of value to those working in social work and in the health care field to develop their skills and competencies as they perform new roles and functions in the complex health care environment.