Skip to main content

Table 1 Organization theory propositions’ potential implications for middle-level managers

From: Using organization theory to position middle-level managers as agents of evidence-based practice implementation

Theory

Proposition

Potential implications for MLMs’ use and selection of implementation strategies

Related MLM role

Contingency theory

The optimal structure of work is contingent on the uncertainty of the task and task environment: When uncertainty is higher, unprogrammed means of coordination will be the more effective way to structure a task; when uncertainty is low, programmed means of coordination will be more effective.

• Evaluate levels of uncertainty associated with implementation and its context. When uncertainty is high, avoid over-prescribing implementation strategies.

• Evaluate levels of uncertainty associated with the implementation context. When uncertainty is high, limit efforts to tailor the context.

• Adapting information, the EBP, and implementation strategies

Higher levels of interdependence (both within and between departments) will require greater investment in coordination (integration).

• Evaluate levels of interdependence required for implementation. For high levels of interdependence, invest resources in facilitating collaboration.

• Mediating between strategy and day-to-day activities

The greater the differentiation among departments, the more difficult it will be to coordinate.

• Identify differences among departments and plan for their implications for implementation efforts.

• Mediating between strategy and day-to-day activities

Resource dependency theory

To acquire power, organizations exchange resources for dependence on other organizations within their field. That is, organizations want autonomy and/or control, but they need resources to survive and/or produce in a way that satisfies stakeholders’ demands.

• Contribute to the adoption decision considering its potential as a form of control—a source of legitimacy in the field, from the perspective of key stakeholders, and boon to the organization’s competitive edgea.

• Compromise autonomy for all of the resources needed for implementation.

• Selling EBP implementation

Competition increases uncertainty perceived by decision makers and decreases willingness to consider, adopt, or implement EBPs.

• Acknowledging abovea, rigorously evaluate, appreciate, account, and plan for stakeholders’ resistance to EBP adoption and implementation.

• Selling EBP implementation

Decreased munificence requires organizations to reduce their dependence on some resources and/or find alternative resources.

• In relatively under resourced organizations, acquire resources for implementation substitute resources with interorganizational partnerships (e.g., collaboratives).

• Obtaining and diffusing information and other resources

Complexity theory

Interdependencies contribute to sense making and self-organization.

• Create opportunities for and facilitate collaborative work among implementers.

• Mediating between strategy and day-to-day activities

Interdependencies among people with diverse perspectives contribute to more effective sense making.

• Engage implementers who have diverse (clinical, cultural, etc.) perspectives.

• Facilitate collaboration among implementers that elicits diverse perspectives.

• Mediating between strategy and day-to-day activities

Feedback loops may amplify some effects and reduce others. At times, small changes will lead to large scale differences in outcomes (i.e., the butterfly effect) and vice versa.

• Monitor influences of changes over time.

• Incorporate findings regarding changes’ influence into subsequent changes.

• Monitor subsequent changes and repeat.

• Obtaining and diffusing information

Change that is guided by minimum specifications allows individuals to self-organize most effectively.

• Build autonomy into implementers’ positions.

• Adapting information and the EBP

The whole system is greater than the sum of its parts.

• Monitor processes and outcomes at organization and system levels.

• Obtaining and diffusing information

  1. aEBP evidence-based practice