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Middle manager involvement in strategy development in not-for profit organizations: the director of nursing perspective – how organizational structure impacts on the role


Marie Carney Lecturer
Head of School of Nursing and Midwifery
University College Dublin


Aim  An attempt was made to link organizational structure and strategic management and, in the process, to identify how organizational structure impacts on the strategic management role of Directors of Nursing working in acute care hospitals in the Republic of Ireland.

Background  Directors of Nursing are recognized as holding a pivotal role in health care delivery. The need for their involvement in strategic management is acknowledged, yet it is not clear if this role is influenced by organizational structure. It is recognized that strategic involvement increases the likelihood that middle managers’ initiatives will be in line with top management's concept of corporate strategy.

Key issues  The principal thesis is that organizational members will exercise a higher level of strategic consensus if they have been initially involved in the development of strategy.

Conclusion  The study was undertaken in not-for-profit health service organizations, through a series of 25 semi-structured interviews with Directors of Nursing. The review of the literature was undertaken simultaneously with grounded theory analysis of the interviews. This research suggests that structure does impact on the role, conferring both positive benefits and negative consequences. Structure is identified in this study, in terms of organizational hierarchy, and the locus of control pertaining in each organization. Two predominating structure models are discussed and analysed.