Table 4 Determinants of middle managers’ roles identified in included studies

 Evidence strength and quality

Middle managers’ perceptions of the quality and validity of evidence supporting the belief that the innovation will have desired outcomes.

“It’s important that ... there’s also some evidence to demonstrate that they [clinicians] are following what is considered best practice” [32].

 External policies and incentives

Includes external strategies to spread innovations including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaborative, and public or benchmark reporting.

“Managers from non-adopting districts reported the main reason for not adopting the project were mostly related to the organizational stability as many of them had experienced or anticipated restructurings within the near future” [23].

 Networks and communications

The nature and quality of webs of social networks, and the nature and quality of formal and informal communications within an organization

“Inadequate performance measurement due to lack of communication between supervisors and subordinates made setting performance standards challenging” [29].

 Implementation climate (leadership engagement)

The absorptive capacity for change, shared receptivity of involved individuals to an innovation, and the extent to which use of that innovation will be rewarded, supported, and expected within their organization

“Top managers’ support had a large and significant effect on [middle managers’] commitment; mediators identified were human resources, training, and funding” [4].

 Available resources

The level of resources organizational dedicated for implementation and on-going operations including physical space and time.

“Implementation of certified practice regulations required the nurse leaders to juggle complex and intersecting fiscal and human resource concerns” [33].

 Culture

Norms, values, and basic assumptions of a given organization.

“There appeared to be a special synergy at clinics in which administrators and clinicians shared a vision and goals” [34].

 Knowledge and beliefs about the EBP

Middle managers’ attitudes toward and value placed on the innovation, as well as familiarity with facts, truths, and principles related to the innovation.

“The practice manager’s perception of the ability of the web based care plan to reduce the general practitioner’s workload influenced their decision to encourage the general practitioner to adopt the new system for care planning” [35].

 Self-efficacy

Middle managers belief in their own capabilities to execute courses of action to achieve implementation goals.

“Many supervisors felt inadequate to supervise EBP implementation” [36].

 TDF: skills

Middle managers ability or proficiency acquired through practice.

“Possessing people skills and knowledge of the oncology department workflow was necessary to successfully plan an engaging training” [37].

 TDF: beliefs about capabilities

Acceptance of the truth, reality or validity about an ability, talent or facility that a person can put to constructive use

“One of the main barriers is fear of exercising authority and being in agencies that do not demand it” [36].

 TDF: social/professional role and identity

A coherent set of behaviors and displayed personal qualities of an individual in a social or work setting

“One of the key implementation determinants is role/identity (i.e., roles and relationships, working practices, multiple reorganizations, leadership type or lack thereof” [38].

 TDF: competing task demands

Middle managers conflicting roles and/ or competing demands.

“Some junior managers felt overburdened by their workload” [39].