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The purpose of this paper is to address a missing link between top management and employees when it comes to understanding how to successfully implement and embed workplace health promotion (WHP) as a strategy within organizations: the role of the middle managers.

A conceptual framework based on review of theory is applied within an empirical multi-case study that is part of a health intervention research project on increased physical activity among office workers. The study involves six Danish organizations.

Middle managers play a key role in successful implementation of WHP, but feel uncertain about their role, especially when it comes to engaging with their employees. Uncertainty about their role appears to make middle managers reluctant to take action on WHP and leave further action to top management instead.

Limitations included the middle managers’ low attendance at the half-day seminar on strategic health (50 percent attendance), the fact that they were all office workers and they were all from Denmark.

Middle managers ask for more knowledge and skills if they are to work with WHP in daily business.

Implementing and embedding WHP as a health strategy raises ethical issues of interfering with employees’ health, is seen as the employee’s personal responsibility.

This study adds to knowledge of the difficulties of implementing and embedding WHP activities in the workplace and suggests an explicit and detailed research design.

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

This paper aims to examine why the sustainability paradox exists and how it unfolds by focusing on intraorganizational dynamics. It explores how organizational actors perceive and make sense of sustainability and thereby contribute to the sustainability paradox.

In a case study on IREN, an Italian listed multi-utility with considerable engagements with sustainability, data collection through interviews, e-mails and document analysis revealed contradictions raised by directors and middle managers. Findings were analyzed by iterating with the literature used to frame this study, which combines organizational sensemaking, paradoxes and management control.

The sustainability paradox comprises various facets. Directors and middle managers interpret sustainability differently depending on their role within the organization and their perceptions of the concept itself. Different interpretations thus occur within and across organizational levels and functions, impacting how sustainability is implemented and monitored. The use of parallel management control systems (MCSs) reflects multiple and fragmented sensemaking, which explains the facets of the sustainability paradox.

Although this work illuminates the role played by individuals at top- and middle-management organizational levels and MCSs in relation to the sustainability paradox, more research is needed on how individuals make sense of sustainability at the lowest organizational levels.

Organizations claiming commitment to sustainability must establish communication forms on the practicalities of sustainability throughout the organization to stimulate shared sensemaking and the design and use of inclusive MCSs.

This paper explains why and how organizations unconsciously enact various facets of the sustainability paradox.

The purpose of this study is to describe primary health-care managers’ perceptions of management competencies at different management levels in digital health services using the management competency assessment program as a framework.

A secondary analysis study involving 21 semi-structured individual interviews was conducted among Finnish primary health-care managers at different management levels (frontline, middle and senior). The deductive framework method was used to analyze the data.

Similarities and differences were found in management competencies between different levels of management. Competencies related to the use of digitalization were highlighted by managers at all management levels. Managers at all management levels were involved in developing digital solutions and supporting employees in using digital solutions in their work. Frontline and middle managers emphasized more issues related to day-to-day management and communication with employees, whereas senior managers highlighted the management of large entities.

In the secondary analysis, data were used for purposes other than originally intended. Therefore, the data are subject to limitations of the methodology applied and should be transferred to other contexts with caution.

Identifying the management competencies needed to manage digital health services is important to target managers’ training according to needs in the future.

The results could be used to develop the management of digital health services, as well as improve digital health services and their deployment.

Previous literature mostly examined managers’ informatics competencies and paid little attention to other management competencies. This study discusses more broadly the management competencies that digital health services require from managers at different levels of management.

This study aims to investigate the influence of budgeting design characteristics on perceived budgeting usefulness, based on the enabling-coercive framework.

This paper develops a survey in one large publicly-listed Brazilian company that operates in the electric utility industry. The sample comprises 75 middle managers from different areas of this organization. This study uses structural equation modeling as the data analysis method.

The results indicate that internal and global transparencies determine middle managers’ perceptions of budgeting usefulness, while no relationship was found for repair capacity and flexibility characteristics. This paper shows that managers, when provided with global and internal transparencies and independently of their level discretion regarding target revisions or the reallocation of resources, perceive budgeting systems as being useful for decision-facilitating and decision-influencing roles.

The findings might be relevant for budgeting professionals to review or design the budgeting system in terms of dribbling potential flaws and increasing its use in the organization.

The study explores the multidimensionality of the enabling-coercive budgeting design construct. This study provides a theoretical contribution to the literature by showing that budget alignment, integration, learning and information sharing are relevant such that an organization could improve the assertiveness using budgeting systems. Besides, this paper provides an opposing view about the supposed relation between flexible budgeting design and budgeting usefulness. Frequently, some management directions are offered by the literature and no guarantee is provided in terms of the connection between the adoption and the usefulness of those mechanisms. Therefore, the findings shed more light on the practical developments in budgeting.

This study examines whether managerial capability fit between line managers, middle managers and top-level managers enhances effectiveness.

Effectiveness data and managerial capability ratings from more than 1,600 manager–supervisor dyads were collected in the United States and Germany. Polynomial regression was used to study the relation between manager–supervisor fit and managerial effectiveness.

Our results indicate that the fit of managerial capabilities between a manager and his/her supervisor predicts the effectiveness of this manager. The most effective managers show particularly high managerial capabilities that are in line with predominantly high managerial capabilities of their supervisors. Two aspects are important: the manager–supervisor fit and the absolute capability level that both possess. The results further indicate that the importance of the manager–supervisor fit varies across lower, middle and top-level management dyads.

This study contributes by advancing research on managerial capability fit conditions between managers and their supervisors as a central element in viewing and managing effectiveness.

This article informs managers, supervisors and HR professionals about pitfalls in organizations that degrade effectiveness.

This article shows how the alignment between managers and their supervisors relates to effectiveness in a large-scale study across different hierarchical levels.

The purpose of this study is to identify factors that foster or prevent sense of belonging among frontline and middle managers in social and health-care services in Finland.

The data have been collected among social and health-care managers (n = 135; 64 per cent nursing managers) through two open-ended questions in a questionnaire concerning sense of community. The results of the open-ended questions have been analyzed using qualitative content analysis.

Among managers, six categories of factors that foster sense of belonging (open interaction, effective conversation culture, support and encouragement, common values, a shared vision of the work and its objectives and structure of leadership) and five categories of factors that prevent sense of belonging (negative work atmosphere, lack of common time, structural solutions in the organization, problems that occur in the organizational level and problems related to leadership and management) have been identified.

The resulting information can be used to develop sense of belonging among managers at all levels of organization (horizontal and vertical).

Paying attention to the quantity and quality of interaction and to structural solutions in the organization can affect the sense of belonging among frontline managers and middle managers.

The purpose of this paper is to contribute to the successful implementation of digitalization by exploring what characterizes strategy work undertaken by companies that have achieved digital transformation. Based on empirical data, the authors delineate five essential strategic actions that are prerequisites for digital transformation: discuss and communicate the vision and strategy; align resources and activities with the strategy; ensure a continuous focus on operational improvements and efficiency; create an orientation toward customer or user needs and expectations; and develop the competencies of top managers, middle managers and employees.

Between January 2021 and February 2022, the authors conducted a survey on strategy work in Danish organizations with 2,251 respondents. The respondents encompass top managers, middle managers and employees representing 1,164 organizations.

The authors identify five strategic actions that positively influence whether organizations incorporate digitalization into their strategy work. These strategic actions can support organizations in their strategy work regarding digital transformation and offer valuable insights and inspiration for leaders currently undertaking the journey of digital transformation.

Based on the empirical data, it is not possible to deem one action as more important than another in the context of digital transformation, as each action contributes significantly to facilitating the process. Given the nature of empirical data, the strategic actions reflect correlation rather than causation.

The empirical insights provide valuable practical guidance for leaders in managing digital transformation as a part of strategy work, which is typically discussed in a more conceptual manner. In addition, the authors identify new areas for further in-depth exploration in practice.

Due to the “European Union Framework Directive on Safety and Health at work” (Directive 89/391/EEC, 1989), every employer is obliged to avoid psychosocial hazards when designing work. Little is known empirically about the barriers that workplace actors experience while developing and implementing OSH measures that prevent psychosocial hazards. The purpose of this paper is to explore barriers, causes and attempts to overcome them and discusses them with reference to relevant theoretical concepts and models that help to explain how these barriers hinder the development and implementation of OSH measures.

Semi-structured interviews with workplace actors in charge of psychosocial risk assessment (PRA) were conducted in 41 business cases, and transcripts were analysed using a thematic analysis approach. Barriers, causes and attempts to overcome them were extracted inductively and discussed with reference to relevant theories and explanatory models.

The complex nature of psychosocial risks, hindering general beliefs, lack of a perceived scope for risk avoidance, lack of assumptions of responsibility among players on all hierarchical levels, discrepancies between formal responsibility and decision authority, and low reflexivity on processes of development and implementation of interventions were described as barriers. Causes and attempts to overcome these barriers were reflected upon by workplace actors.

Recommendations on the organisation of PRA will be given with respect to the reported results and relevant research in this field.

This qualitative study explores the barriers to developing and implementing OSH measures to eliminate psychosocial hazards, from the perspective of actors in charge of PRA, and why they might fail.

The aim of this paper is to contribute to a greater understanding of non-profit organization (NPO) management control systems (MCS) and accountability in organizations providing support service for capacity constrained service users. Specifically, the paper examines the role of MCS and accountability in supporting mission realization in NPOs providing services to people with intellectual disabilities and reflects on this in the context of the COVID-19 pandemic.

The research comprised a case study of four NPOs providing services to people with intellectual disabilities in Ireland conducted prior to the global COVID-19 pandemic. The study probed management's perceptions of stakeholders and examined the manner in which the design and use of MCS and accountability processes supported mission realization.

Service users were regarded as the least powerful stakeholder and consequently the least attended to in terms of MCS and accountability processes. The absence of relational and dialogical accountability with service users is not only central to maintaining this power asymmetry but also poses a threat to mission realization. These deficits can be addressed through the integration and monitoring of internal advocacy activities into MCS and accountability processes, which, on reflection, may also mitigate some of the negative consequences for service users of isolation from external support networks in times of crisis.

This research has opened up an area for enquiry – internal advocacy – heretofore not addressed in the management accounting literature, opening up a novel vein for future research. Such research could further examine the role of internal advocacy, drawing from and adding to the research in other support service domains. A number of objectives and questions might be considered: (1) probing the level of management recognition of the role of direct engagement in advocacy activities in supporting service user agency; (2) identifying with service users and management the nature and attributes of effective advocacy activities and practices; (3) questioning how such advocacy activities and practices might be reflected in MCS; (4) identifying what service user stakeholders regard as effective accountability to them in relation to their needs and objectives; and (5) assessing the impact on service user experience and on NPO mission realization of internal advocacy activities and the monitoring and review thereof through MCS. These suggestions for future research draw attention to aspects of support service delivery that have the potential to be profoundly influential on service outcomes.

A performance management model reflecting the identified need to incorporate internal advocacy mechanisms into organizational management control systems is proposed in an effort to increase accountability of NPOs to their core mission stakeholder – service users. This model may be of value to NPO management as they move from a medical-model of care to a rights-based model for service delivery in care settings.

The paper reflects the importance of listening to the voice of vulnerable service users in NPO care settings and proposes a mechanism for embedding internal advocacy in formal management control systems and accountability processes.

In proposing an “agency” supportive relational and dialogical accountability logic for such organizations, underpinned by “internal advocacy”, this research provides theoretical and practical insights for accountability processes and the design of MCS. The findings contribute empirically, not just to the NPO management and MCS literature but also to understanding the relational interaction of service users with service organizations, and what this means in supporting service user objectives and realization of organizational mission.