A Multi-Methods Study of the Role of Middle Managers in Brokering Knowledge in Hospitals

Hospitals are complex environments that are accountable for the quality of the services they provide. The quality of care in hospitals, however, is often less than ideal – patients may not receive treatments with proven effectiveness or may receive unnecessary or even potentially harmful care (Grimshaw et al., 2012; McGlynn et al., 2003). Hospital managers play a pivotal role in facilitating high quality care and may play a brokerage role in the sharing and use of knowledge in healthcare organizations (Birkin et al., 2018; Urquhart et al., 2019). The body of research on knowledge brokers (KBs) suggests that they may have multiple roles, but prior research has focused primarily on KBs in formal roles external to the practice community they seek to influence (CHSRF, 2003). Little is known about internal KB roles, and it remains unclear how the KB role is enacted in health care. There is a dearth of research on what impact KBs within organizations have in brokering knowledge in hospitals (Burgess Currie, 2014; Glegg Hoens, 2016). Although middle managers (MMs) may potentially play a key role as KBs, how MMs act as KBs in health care has not been adequately studied in Canada or elsewhere (Birkin et al., 2018; Currie et al., 2014). This multi-methods study examined the role that MMs play in brokering knowledge in hospitals, the determinants of their KB efforts, and the impact of those efforts. The findings of a qualitative descriptive study, using semi-structured interviews with MMs in hospitals across Ontario, Canada, conducted concurrently with a Critical Interpretive Synthesis of the literature, found that MMs enact many of the roles and activities of knowledge brokers in hospitals to create, share or implement an innovative or evidence-based practice. In addition to roles and activities, this study contributes to the extant literature by revealing determinants that may influence MM KBs efforts and their impact in hospitals and by providing actionable insights into how to optimize the role. This study also makes recommendations that administrators and policy makers can use to strengthen KB roles to better equip MM KBs to ultimately improve quality of care.Ph.D