The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

Faith Boutcher; Whitney Berta; Robin Urquhart; Anna R Gagliardi

doi:10.1186/s12913-021-07387-z

The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

BMC Health Serv Res. 2022 Jan 2;22(1):11. doi: 10.1186/s12913-021-07387-z.

Authors

Faith Boutcher¹, Whitney Berta², Robin Urquhart³, Anna R Gagliardi⁴

Affiliations

¹ Baycrest Health Sciences, 3560 Bathurst Street, Toronto, Ontario, M6A 2E1, Canada. fboutcher@baycrest.org.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building Suite 425, 155 College Street, Toronto, Ontario, M5T 3M6, Canada.
³ Department of Community Health and Epidemiology, Dalhousie University, Room 413, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada.
⁴ University Health Network, 13EN-228, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.

Abstract

Background: Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts.

Methods: We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results.

Results: We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes.

Conclusion: Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework.

Trial registration: A protocol for this review was not registered.

Keywords: Critical interpretive synthesis; Knowledge brokers; Middle managers.

Publication types

Review

MeSH terms

Delivery of Health Care
Evidence-Based Practice
Humans
Knowledge*
Organizations*