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Health Care Manage Rev. 2018 Jul/Sep;43(3):218-228. doi: 10.1097/HMR.0000000000000174.

The impact of middle manager affective commitment on perceived improvement program implementation success.

Author information

Ashley-Kay Fryer, PhD, is Director of Strategy, Optum Analytics, Boston, Massachusetts. E-mail: Anita L. Tucker, DBA, is Associate Professor, Questrom School of Management, Boston University, Boston, Massachusetts. Sara J. Singer, PhD, MBA, is Professor of Health Care Management and Policy, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.



Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success.


We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment.


We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success.


Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success.


We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program.


Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.

[Indexed for MEDLINE]

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