How Middle Managers Affect Frontline Idea Generation: Evidence From Healthcare Operations

ABSTRACT This multiple case study develops a mid‐range theory on how frontline idea generation is affected by the actions of an organization's middle management. The study draws from four acute‐care hospitals in Germany and involves 36 semi‐structured interviews with representatives from all hierarchy levels. We use mission statements from these hospitals to measure top management's strategic intent regarding frontline idea generation. Then we analyze the idea generation performance of 156 nurses from the hospitals and link it to specific middle management behaviors. The cross‐case analyses reveal that middle managers' shaping of nurses' innovation identity improves nurses' idea generation performance. However, this connection also means that middle managers' own forays into innovation can impede frontline idea generation. We find that middle managers' supportive behavior is largely independent of top management intent, a dynamic that offers both advantages and risks. These insights extend our knowledge about the role of middle managers in frontline idea generation.