There are libraries full of research and case studies on how doctors (and increasingly other health professionals) as well as executives, influence the implementation of healthcare improvement and innovation. Middle managers, the cream in the éclair (often squeezed out) have not been in the headlines. But there is a new paper out which looks at their role and its importance. More research is needed.
Implement Sci. 2012 Apr 3;7(1):28.
Uncovering middle managers' role in healthcare innovation implementation.
Birken SA, Lee SY, Weiner BJ.