HR Practices and Knowledge Brokering by Hybrid Middle Managers in Hospital Settings: The Influence of Professional Hierarchy

• Author: Graeme Currie,James C. Hayton,Nicola Burgess
• DOI: http://doi.org/10.1002/hrm.21709
• Published date: 01 September 2015
• Date: 01 September 2015

Human Resource Management, September–October 2015, Vol. 54, No. 5. Pp. 793–812

© 2015 Wiley Periodicals, Inc.

Published online in Wiley Online Library (wileyonlinelibrary.com).

DOI:10.1002/hrm.21709

Correspondence to: Graeme Currie, Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK,

Phone: +44(0) 2476 528432, E-mail: Graeme.currie@wbs.ac.uk

HR PRACTICES AND KNOWLEDGE

BROKERING BY HYBRID MIDDLE

MANAGERS IN HOSPITAL SETTINGS:

THE INFLUENCE OF PROFESSIONAL

HIERARCHY

GRAEME CURRIE, NICOLA BURGESS,

ANDJAMESC.HAYTON

Drawing upon the ability-motivation-opportunity (AMO) framework, our study

extends understanding of the interaction between human resource (HR) prac-

tices and the brokering of knowledge by hybrid middle managers. Examining

health care delivered to older people in a hospital setting, our study highlights

that hybrid nurse middle managers broker knowledge downward through pro-

fessional hierarchy to their peer group, but fi nd it diffi cult to broker knowledge

upward. Meanwhile, because they lack legitimacy with doctors, they lack the

opportunity to broker knowledge interprofessionally. Hybrid medical middle

managers are potentially more able to broker knowledge within their peer group.

However, some of lower status intraprofessionally, like nurses, may lack legiti-

macy and opportunity to do so. Meanwhile, higher-status medical middle man-

agers may lack motivation to engage in knowledge brokering with peers outside

their specialism. We suggest that inter- and intraprofessional power and status

has important implications for HR practices to support knowledge brokering by

hybrid middle managers. Should HR practices fail to support ability, motivation,

and opportunity for knowledge brokering across and within professions, then a

“broken” rather than “ broker” chain may result. © 2015 Wiley Periodicals, Inc.

Keywords: HR practices, AMO framework, health care, hybrid, middle managers,

knowledge broker

In line with research that examines how health

outcomes are affected by human resource

(HR) practices (Buttigieg, West, & Dawson,

2011; West, Guthrie, Dawson, Borrill, &

Carter, 2006), we need to understand how

such management practices best support the

knowledge-brokering role of hybrid middle man-

agers. Knowledge brokering is a specific phenom-

enon within the wider knowledge mobilization

literature, defined as “getting the right knowledge,

into the right hands, at the right time” (Currie &

White, 2012; Hargadon, 2002; Verona,Prandelli,

794 HUMAN RESOURCE MANAGEMENT, SEPTEMBER–OCTOBER 2015

Human Resource Management DOI: 10.1002/hrm

Hybrid middle

managers are

defined as “mediating

persons” capable of

working through sets

of ideas belonging

to management and

those belonging to

clinical practice.

most common patient safety issues in the English

NHS for older people: patient falls, medication

management, and transition (within hospitals

between departments and between hospitals and

the patient’s home, care home, or intermedi-

ate care setting; National Patient Safety Agency,

2007). Our study draws data from three hospitals,

encompassing 127 interviews, 16 hours of focus

group discussion with 48 clinical staff, and 60

hours of observation. As prior academic commen-

taries have emphasized, unique insights into the

interaction of HR practices with knowledge mobi-

lization are likely to be gleaned from the study

of employees, rather than the HR function itself

(Bowen & Ostroff, 2004; Kehoe & Wright, 2013;

Piening, 2014; Wright & Boswell, 2002).

Knowledge Brokering by Hybrid Middle

Managers in Health Care Organizations

Hybrid refers to managers who are skilled in an

alternative profession. Llewellyn (2001) describes

the hybrid concept using a metaphor of a “two-

way window,” where middle managers with a

clinical background act as “mediating persons”

capable of working through sets of ideas belong-

ing to management and sets of ideas belonging

to clinical practice. In the English NHS, hybrid

middle managers have different professional back-

grounds and are located at different levels of the

organization. Within our case studies, for exam-

ple, hybrid middle managers encompass senior

nurses with responsibility for ensuring clinical

governance, those leading care delivery teams

at ward level, and consultants leading medical

teams in different specialties. We highlight that,

while general managers or “pure plays” represent

around 3 percent of the management workforce,

hybrid managers have been calculated to repre-

sent around 30 percent of staffing of a typical hos-

pital in the English NHS (Buchanan etal., 2013;

Walshe & Smith, 2011). Thus, their strategic role

is potentially significant, and so we might expect

attention to HR practices that support enactment

of a knowledge-brokering role from hybrid mid-

dle managers. In theory, hybrid middle managers,

through brokering knowledge, influence strategy

in a downward manner, convergent with senior

management plans, but also exert strategic influ-

ence upward and divergent from senior manage-

ment plans (Floyd & Wooldridge, 1992, 1997).

In considering knowledge mobilization within

health care settings, it is necessary to acknowl-

edge the nature of a professional organization,

which is hierarchical (Abbott, 1988; Freidson,

1988). Regarding their strategic contribution, Shi,

Markoczy, and Dess (2009) highlight that some

hybrid middle managers enjoy more legitimacy,

& Sawhney, 2006), which has been particularly

applied to middle managers (Delmestri, 2005).

Hybrid middle managers are defined as “medi-

ating persons” capable of working through sets

of ideas belonging to management and those

belonging to clinical practice (Llewellyn, 2001).

These unique managers are crucial brokers for

knowledge, upward and downward within a

health care provider, for quality improvement

(Burgess & Currie, 2013).

To understand this phenomenon, we draw

upon a burgeoning literature on the interaction

of HR practices with knowledge mobilization (e.g.,

Collins & Clark, 2003; Foss, Minbaeva, Pedersen, &

Reinholt, 2009; Kang, Morris, & Snell, 2007; Kang,

Snell, & Swart, 2012; Krausert, 2014; Minbaeva,

Foss, & Snell, 2009). More specifically, we draw

upon the ability-motivation-opportunity (AMO)

framework to understand how HR practices best

support the knowledge-brokering role of hybrid

middle managers (e.g., Blumberg

& Pringle, 1982; Bos-Nehles, Van

Riemsdijk & Kees Looise, 2013;

Gagné, 2009; McDermott, Conway,

Rousseau, & Flood, 2013; Minbaeva

etal., 2009; Prieto & Pérez Santana,

2012). While literature is burgeon-

ing around how HR practices medi-

ate knowledge mobilization, there is

little consideration of its impact in

professional organization, character-

ized by power and status hierarchies.

Such considerations are crucial in

understanding the functioning of

professional bureaucracies, such as

hospitals (Mintzberg, 1979).

We focus on care of older people

in English hospitals and brokering

of patient safety knowledge, defined as knowledge

that is critical to ensure the quality of care is at an

optimum safe level for patients. Safe care of older

people represents a significant issue globally, due

to increasing numbers of older patients, the high

costs of their more complex condition (comorbid-

ity), and the tendency to remain in the hospital

longer (Appleby, 2013). A recent government-level

inquiry within the English National Health Service

(NHS) highlighted failure in the delivery of care of

older people at one hospital, the Mid-Staffordshire

NHS Foundation Trust, which has driven system-

level change across England to enhance quality.

A large part of this relies on the development of

hybrid middle managerial capacity to achieve the

needed improvements in quality of care through

brokering of patient safety knowledge (Francis,

2013). Within our study, we examine knowledge

brokering by hybrid middle managers around the