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This article reconciles mixed findings about the performance impact of middle managers' strategy involvement. We propose that the relationship between middle managers' adaptive strategy implementation—through upward and downward influence—and objective business performance can be curvilinear and contingent on formal and informal structures. Applying a multilevel perspective to social networks, we empirically show that reputational social capital enhances the performance impact of middle managers' upward influence while informational social capital elevates the performance impact of their downward influence. The size of a business unit or region has differntial moderating effects. The curvilinear effects of middle managers' upward influence and reputational and informational social capital on business unit performance reflect paradoxes. We discuss the implications of these findings for strategy implementation research and practice.

Background The use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice. Methods EvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives’ implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts. Results Thirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale. Conclusions Findings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts. Trial registration Registered as Observational Study at www.clinicaltrials.gov ( NCT02560428 ).

Abstract Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward. Implementation strategy fidelity, or the extent to which an implementation strategy is carried out as it was designed, is under-developed and under-reported, and the quality of reporting is decreasing over time. This position paper describes the costs and benefits of implementation strategy fidelity. We ultimately call for the continuation and improvement of implementation strategy fidelity measurement while offering pragmatic solutions to noted challenges. Future research is needed regarding the barriers and facilitators to implementation strategy fidelity measurement and reporting, the costs and cost-benefits of implementation strategy fidelity measurement, and the relationship between implementation strategy fidelity and implementation and clinical outcomes.

It is often claimed that 50–90% of strategic initiatives fail. Although these claims have had a significant impact on management theory and practice, they are controversial. We aim to clarify why this is the case. Towards this end, an extensive review of the literature is presented, assessed, compared and discussed. We conclude that while it is widely acknowledged that the implementation of a new strategy can be a difficult task, the true rate of implementation failure remains to be determined. Most of the estimates presented in the literature are based on evidence that is outdated, fragmentary, fragile or just absent. Careful consideration is advised before using current estimates to justify changes in the theory and practice. A set of guiding principles is presented for assisting researchers to produce better estimates of the rates of failure.

BackgroundEffective strategy implementation is crucial for public sector organisations. Despite the importance of strategic planning, many public organisations struggle with execution, leading to performance gaps. This study addresses the limited research on strategy implementation in public companies.AimThis study investigates how strategy implementation practices – focusing on organisational capability, internal processes and implementation styles – impact the performance of public companies.SettingThe research was conducted in Malawi, involving state-owned enterprises responsible for electricity generation and distribution.MethodsA quantitative design was used, with structured surveys distributed to 304 employees. Ordinal logistic regression analysis examined the relationships between strategy implementation practices and organisational performance.ResultsThe findings reveal that organisational capability and internal processes significantly enhance performance. Rational strategy implementation alone did not directly impact performance but incremental strategy implementation showed a strong positive influence on performance, emphasising the value of adaptability; however, beyond a certain point, excessive flexibility hindered performance, underscoring the need for balance in strategy execution styles.ConclusionPublic organisations should prioritise investments in organisational capabilities, balance strategy implementation styles and align internal processes with strategy to optimise performance.ContributionThis study advances strategic management theory by integrating the Resource-Based View and Dynamic Capabilities Theory, offering insights into improving strategy implementation in public electricity utility organisations.

Background Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps in care. Though routine data provide opportunities to guide these efforts, frontline providers are rarely engaged in analyzing them for facility-level decision making. The Systems Analysis and Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages providers in use of facility-level data to promote systems-level thinking and quality improvement (QI) efforts within multi-step care cascades. SAIA was originally developed to address HIV care in resource-limited settings but has since been adapted to a variety of clinical care systems including cervical cancer screening, mental health treatment, and hypertension management, among others; and across a variety of settings in sub-Saharan Africa and the USA. We aimed to extend the growing body of SAIA research by defining the core elements of SAIA using established specification approaches and thus improve reproducibility, guide future adaptations, and lay the groundwork to define its mechanisms of action. Methods Specification of the SAIA strategy was undertaken over 12 months by an expert panel of SAIA-researchers, implementing agents and stakeholders using a three-round, modified nominal group technique approach to match core SAIA components to the Expert Recommendations for Implementing Change (ERIC) list of distinct implementation strategies. Core implementation strategies were then specified according to Proctor’s recommendations for specifying and reporting, followed by synthesis of data on related implementation outcomes linked to the SAIA strategy across projects. Results Based on this review and clarification of the operational definitions of the components of the SAIA, the four components of SAIA were mapped to 13 ERIC strategies. SAIA strategy meetings encompassed external facilitation, organization of provider implementation meetings, and provision of ongoing consultation. Cascade analysis mapped to three ERIC strategies: facilitating relay of clinical data to providers, use of audit and feedback of routine data with healthcare teams, and modeling and simulation of change. Process mapping matched to local needs assessment, local consensus discussions and assessment of readiness and identification of barriers and facilitators. Finally, continuous quality improvement encompassed tailoring strategies, developing a formal implementation blueprint, cyclical tests of change, and purposefully re-examining the implementation process. Conclusions Specifying the components of SAIA provides improved conceptual clarity to enhance reproducibility for other researchers and practitioners interested in applying the SAIA across novel settings.

We prove—in the standard independent private-values model—that the outcome, in terms of interim expected probabilities of trade and interim expected transfers, of any Bayesian mechanism can also be obtained with a dominant-strategy mechanism.

PurposeStrategy implementation is a critical component of firm performance and middle managers play a key role in the implementation process. This study was conducted to enhance the authors’ understanding of how middle managers influence strategy implementation (SI) effectiveness by investigating the impact of leadership and work team coordination.Design/methodology/approachA field study was conducted using interviews and survey data gathered from executive managers, middle managers and work team members within a large municipal organization undergoing a major strategic change.FindingsMiddle manager transformational and instrumental leadership have a direct positive impact on work team SI effectiveness. Additionally, middle manager transformational leadership has an indirect positive effect on work team SI effectiveness through coordination.Practical implicationsThe study offers insights into managers and practitioners seeking to improve SI effectiveness by highlighting the importance of middle manager leadership development and the coordination of interdependent tasks within work teams.Originality/valueThe study provides valuable insight into an important but previously unstudied relationship between middle manager leadership and SI effectiveness. The work also helps bridge the chasm between leadership research and strategy research by linking leadership behavior to SI effectiveness – a key ingredient of firm performance.

We characterize dominant-strategy incentive compatibility with multidimensional types. A deterministic social choice function is dominant-strategy incentive compatible if and only if it is weakly monotone (W-Mon). The W-Mon requirement is the following: If changing one agent's type (while keeping the types of other agents fixed) changes the outcome under the social choice function, then the resulting difference in utilities of the new and original outcomes evaluated at the new type of this agent must be no less than this difference in utilities evaluated at the original type of this agent.

Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. Methods This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). Results In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. Conclusion NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.