Middle management involvement in handling variable patient flows

Purpose - This study aims to explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital. Design/methodology/approach - Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement. Findings - In managing variable acute patient flows, middle management adopts a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute patient flow should be managed, are contributing factors to this behavior. Research limitations/implications - The research is based on an explorative, single case study methodology. Future research assessing the extent of different middle management roles in health care, in which more empirical data and quantitative analysis is conducted, is encouraged. Practical implications - There is a need for top management to establish long-term goals to enhance middle management roles when developing strategies for managing variable patient flows. Originality/value - Middle management involvement in developing strategies for managing variable patient flows is a novel topic for research. The interface and division of tasks between top and middle management is crucial for successful strategies in managing variable patient flows.