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This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals’ engagement.

Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method.

The top managers had the intention to balance between quality of patient care, economy and professionals’ engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus.

For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals’ engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals’ engagement. However, this study builds on a limited number of participants. More research is needed.

Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals’ engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.

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.

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.

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 paper is to explore the scope for action of local human resource managers, who are employed in foreign subsidiaries of multinational companies (MNCs), for implementing training activities. These managers are situated in relationships to headquarters and the local environment. Related to this is the question whether MNCs contribute to the local skill base by implementing training activities or whether they exploit the existing skill formation system.

This study focusses on German subsidiaries of MNCs with headquarters in the USA and the UK, France, China and Japan. The study is based on 107 expert interviews with subsidiary managers and representatives of local stakeholder organisations, such as educational organisations, chambers, economic promotion agencies and governmental bodies in Germany.

The study reveals that headquarters introduce general schemes for training. In addition to these MNC-internal trainings, local managers use their information advantage over headquarters to implement dual training activities.

The training activities of subsidiaries are dependent on the institutional settings of the host country.

Albeit dual training activities are laborious and tie the local managers down for the medium and long term, the future need of the subsidiary for adequately skilled workforce prompts local managers’ engagement in implementing dual training activities.

Subsidiaries contribute to the local skill base and do not act in a free-rider position, at least in the German variety of capitalism.

The study deepens insights on distanced relations within and how subsidiaries generate scope for action by using this kind of relationships.

The purpose of this paper is to explore the role of leadership in management accounting change processes and outcomes.

The paper draws on an ethnographic study in a Southern European company and mobilizes leader–follower relations as a method theory to analyse the observations.

The findings show how a leadership dispute between two top managers can be amplified during the management accounting change process and percolate throughout an organization. The authors identify five contested areas where the role of accounting amplifies the leadership dispute by unfolding its reach to other organizational actors. The leadership dispute can shape and reinforce a fragmented organization, with some organizational members creating convergent leader–follower relations while others divert and fragment with an increased turnover. This amplification can lead to unexpected outcomes of the change process in terms of how and by whom accounting is performed.

The authors propose the study of leadership and followership as an important but, to date, largely neglected theme in management accounting research.

In contrast to the prior management accounting literature, the paper departs from a leadership-centric and role-based approach and employs a co-constructionist and relational approach to leadership and followership to analyse management accounting change. In addition, it applies and extends Alvesson's (2019a) theory on “divergent relationalities” between the presumed leaders and followers. In doing so, the paper also adds to the leadership field by theorizing and integrating the situation of a leadership dispute in this novel theoretical framework.

Implementing a new organizational strategy effectively nowadays is said to require open strategizing practices. The purpose of this paper is to examine the adoption of three intertwined open strategizing practices in conjunction with a transformational leadership style towards effective strategy implementation.

The study was conducted within 37 geographically dispersed locations of a Dutch governmental organization. The top managers and senior managers were surveyed at two points in time (n T1 = 548; n T2 = 414) and group interviewed at T2. Exploratory factor and linear regression analyses were performed. The qualitative data pertaining to the specific way in which leaders can impact the relationship between open strategizing practices and strategy implementation was analyzed using the Gioia methodology.

As hypothesized, transformational leadership moderates the positive relationship between open strategizing practices and effective strategy implementation. This moderating effect was corroborated through the interview data in which the managers stressed the need for “intrinsically motivated” and “empowering” leaders to effectively support the adoption of their own locally-developed location strategy, as part of the overall strategy.

Despite the timely focus on the three intertwined open strategizing practices, the findings are only based on the perceptions of the various top and senior managers employed by one Western public sector organization.

Top and senior managers who need to improve their organization's strategy implementation can apply the here tested three open strategizing practices. They should also be aware of the key role of transformational leadership.

The authors contribute to the “open” strategy-as-practice domain by showing how top and senior managers' transformational leadership style supports the beneficial effects of adopting the three practices.

In the context of the COVID-19 pandemic, this study investigates a variety of approaches to supply disruption risk management for achieving effective responses for resilience at the supply management subunit level (e.g. category of items). Drawing on the attention-based view of the firm, the authors model the attentional antecedents of supply resilience as (1) attentional perspectives and (2) attentional selection. Attentional perspectives focus on either supply risk sources or supply network recoverability, and both are hypothesised to have a direct positive association with supply resilience. Attentional selection is top down or bottom up when it comes to disruption detection, and these are hypothesised to moderate the association between disruption risk management perspectives and resilience.

Conducted at the early phases of the COVID-19 pandemic, this study employs a hierarchical regression analysis on a multicountry survey of 190 procurement professionals, each responding from the perspective of their own subunit area of supply responsibility.

Both attentional disruption risk management perspectives are needed to achieve supply resilience, and neither is superior in terms of achieving supply resilience. Both the efficiency of the top down and exposure to the unexpected with the bottom up are needed – to a balanced degree – for improved supply resilience.

The results encourage firms to purposefully develop their supply risk management practices, first, to include both perspectives and, second, to avoid biases in attentional selection for disruption detection. Ensuring a more balanced approach may allow firms to improve their supply resilience.

The results contribute to the understanding of the microfoundations that underpin firms' operational capabilities for supply risk and disruption management and possible attentional biases.

Building on the routine dynamics literature, this paper aims to expand our philosophical, practical and infrastructural understanding of implementing lean production. The authors provide a process view on the interplay between lean operating routines and continuous improvement (CI) routines and the roles of different actors in initiating and establishing these routines.

Using data from interviews, observations and document analysis, retrospective comparative analyses of three embedded case studies on lean implementations provide a process understanding of enacting and patterning lean operating and CI routines in manufacturing SMEs.

Incorporating the “who” and “how” next to the “what” of practices and routines helps explain that rather than being implemented in isolation or even in conjunction with each other, sustainable lean practices and routines come about through team leader and employee enactment of the CI practices and routines. Neglecting these patterns aligned with unsustainable implementations.

The proposed process model provides a valuable way to integrate variance and process streams of literature to better understand lean production implementations.

The process model helps manufacturing managers, policy makers, consultants and educators to reconsider their approach to implementing lean production or teaching how to do so.

Nuancing the existing lean implementation literature, the proposed process model shows that CI routines do not stem from implementing lean operating routines. Rather, the model highlights the importance of active engagement of actors at multiple organizational levels and strong connections between and across levels to change routines and work practices for implementing lean production.

The authors discuss a dominant logic as the main idea behind a global marketing logic (GML) of an MNE and investigate how local stakeholders’ influence the feasibility of applying the GML in emerging markets. The aim of the paper is to enhance the understanding of the factors that influence the local stakeholders' acceptance of the MNEs' GML and the different activities of MNEs that may increase the acceptance.

The authors apply a qualitative case study method investigating three Swedish MNEs and their activities while implementing a GML in the big emerging markets. The authors study their relationships with business, political and social stakeholders.

The authors identify three persistent contents of the GML: (1) a consistent value chain role across markets, (2) standardized, premium products/services and promotion strategies, (3) a corporate brand-based identity. The development of trust, commitment, legitimacy and power within local stakeholders’ relationships influences the approval. The acceptance of the MNE's GML by local stakeholders strengthens its market position.

The authors extend the knowledge by investigating the nature of a GML and explain to what extent it may help MNEs to gain a competitive position. The authors also discuss how global and local activities may influence local stakeholders' acceptance. This study contributes towards a better understanding of how and to what extent a GML can be successful.