• health service management;
  • middle manager;
  • non-clinician;
  • nurse manager;
  • organizational culture;
  • professional clinician;
  • strategic involvement;
  • strategy

Aim  The aim of this study was to explore the extent to which organizational culture influenced strategic involvement.

Background  It is crucial for the strategic management of health care that the cultural dimensions affecting health service organizations are identified and understood. How culture influences middle manager strategic involvement has not been established and therefore an understanding of the power of organizational culture is important to middle managers working in not-for-profit health care organizations.

Conclusion  It was demonstrated that strong organizational culture predicted strategic involvement, and supported the importance of middle managers remaining strategically involved in the development of new organizational strategic initiatives. Findings have implications for strategic management in health service organizations.