Middle managers' role in implementing evidence-based practices in healthcare: A systematic review

Sarah Birken, Alecia Clary, Amir Alishahi Tabriz, Kea Turner, Rosemary Meza, Alexandra Zizzi, Madeline Larson, Jennifer Walker, Martin Charns

Research output: Contribution to journalReview articlepeer-review

55 Scopus citations


Background: Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers' role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers' role in healthcare EBP implementation and determinants of that role. Methods: We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers' role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge. Results: One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers' role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers' role in implementation. However, extant studies offered little understanding of determinants of middle managers' role. Conclusions: Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers' roles and EBP implementation, or determinants of middle managers' role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers' role. Clearer understanding may facilitate the translation of evidence into practice.

Original languageEnglish (US)
Article number149
JournalImplementation Science
Issue number1
StatePublished - Dec 12 2018

Bibliographical note

Funding Information:
Dr. Birken’s effort was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR001109. Ms. Clary’s work on this manuscript was supported by the National Cancer Institute at the National Institutes of Health (R25CA116339). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2018 The Author(s).


  • Evidence-based practice
  • Healthcare
  • Implementation
  • Implementation climate
  • Leader
  • Middle manager
  • Supervisor
  • Systematic review


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