Enabling Frontline Employee Innovation in Hospitals – Evidence from Multiple Case Studies (WITHDRAWN)

In this paper we study how middle managers’ behavior can help foster frontline innovation. First, we develop theory via multiple case studies to identify concrete actions and viewpoints of various management levels regarding frontline ideas. The case data comes from more than 25 semi-structured interviews with representatives from all hierarchy levels at 4 different acute care hospitals in Germany. We further develop a measurement for frontline innovation performance and survey the respective frontline representatives (N=88) from these hospitals. To further delineate the impact of middle manager behavior from other influences, such as top management support, we conducted a second survey with external nurses (N=151) belonging to 16 different hospitals from Germany, who evaluated the frontline innovation involvement of nurses in the studied hospitals. Nothwithstanding the innovation potential of middle managers, our cross-case comparison finds that their own innovation activities can distract them from shaping and supporting the innovation activities of their frontline staff. In contrast, middle managers who are focused on encouraging and involving their frontline staff were able to substitute a lack of top management support and foster a strong frontline innovation performance. Overall, this study sheds light on the intricate role of middle managers as agents for bottom-up frontline innovation and offers important implications for service-driven organizations.