This paper describes the second phase of a research study into the introduction of the ‘modern matron’ role in the National Health Service. It draws on information from a survey of modern matrons in 10 case study trusts and from semistructured interviews with purposively selected matrons and their key contacts. Three models of role implementation are identified, each typical of ‘hybrid management’ but with different emphases on matrons’ professional (clinical) and corporate management responsibilities. There is evidence that matrons are starting to make an impact on different aspects of quality improvement in their trusts, but this is often limited by lack of forethought about where they should be located in the organization. It is suggested that, before making decisions about establishing modern matron posts, trusts need to have a clearer understanding both of the different contributions matrons can make to quality improvement and the challenges posed by this type of role.