The leadership experience: a qualitative study exploring the perceptions of middle managers in an acute healthcare setting

  • Vanya Aquilina

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


Competing tensions are known to be experienced by middle managers in healthcare settings. The increased complexity and higher dynamic nature in acute healthcare contexts increase the demands expected of middle managers. There is limited research focusing on the leadership experience of nurse and allied health middle managers working within acute healthcare contexts. In view of this gap, the aim of this study is to explore the leadership perceptions of nurse and allied health middle managers. Their perceptions of the impact of leadership training and professional development practices are also explored. The Competing Values Framework provides a useful framework for gaining insight into the leadership experience of middle managers. The principal research question is: What is the leadership experience of nurse and allied health middle managers in an acute public general hospital?A qualitative approach using semi-structured interviews was held with nurse and allied health middle managers working within the main acute public general hospital in Malta. Through purposive sampling, 21 middle managers consented to participate in the study. Thematic analysis was conducted identifying codes and themes within the data, from which findings were derived.Findings suggest that nurse and allied health middle managers fulfil contradictory and competing demands within dynamic healthcare contexts, underlining the intense emotions experienced by them, and their struggle to achieve a balance across conflicting situations. Middle managers suggested that they would benefit from communities of practice development approaches and mentoring programmes, to help them cope with workplace demands and the contradictions within their role. A central recommendation of this study is the inclusion of middle managers in planning future leadership training and development programmes. This may be effected through a partnership approach with senior managers and trainers so that training significantly contributes towards enabling optimal performance of middle managers, and the ultimate improvement of patient safety and quality healthcare. This research has implications as to where and how resources for developing middle managers should be invested in acute healthcare contexts.
Date of Award1 Mar 2017
Original languageEnglish
Awarding Institution
  • University of Bath
SponsorsMalta Government Scholarship Scheme
SupervisorZeynep Yalabik (Supervisor) & Maria Cassar (Supervisor)

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