Research Paper: What is the role of a manager in succession planning in a healthcare organization?

Value in the middle: cultivating middle managers in healthcare organizations Alan Belasen MBA Program, Empire State College, Saratoga Springs, New York, USA, and Ariel R. Belasen Department of Economics and Finance, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA Abstract Purpose–Senior executives in healthcare organizations increasingly display preference for a closer handling of operational levels, bypassing middle managers, and de-emphasizing the need to cultivate the next cadre of leaders, creating the potential for leadership and performance gaps. The authors argue that middle managers are a vital resource for healthcare organizations and review the benefits for including them in leadership development and succession planning programs. The paper aims to discuss these issues.

Design/methodology/approach–Current theories and common practices in addition to data collected from government sources (e.g. BLS), business and industry surveys and reports (e.g. Moody’s, Witt/Kieffer, Deloitte, American Hospital Association) are used to classify the roles, skills, and strategic value of middle managers in healthcare organizations.

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Findings–The combination of a greater executive span with less hierarchical depth creates a dual effect of devaluing middle management, and a decrease in middle managers’autonomy. Healthcare middle managers who stay away or lay low further trigger perceptions of low expectations leading to low morale and high levels of stress. Others become hypereffective or develop exit strategies. Major problems are: rising turnover costs; and insufficient attention to succession planning, internal promotion, and leadership development.

Practical implications–The outcomes of this study are useful for management development, particularly at times of change. Practitioners and researchers can have a better understanding of the value of middle managers and their development needs as well as the factors and dynamics that can influence their motivation and affect retention.

Originality/value–Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies can lead to a drastic change in the current perceptions of the importance of middle managers and should lead to long-term retention, well-being, and extrinsic benefits for both the company and its employees.

KeywordsSuccession planning, Healthcare middle management, Hypereffective manager, Middle manager development, Turnover costs, Morale Paper typeViewpoint Introduction TheOccupational Handbook of the Bureau of Labor Statisticsincludes planning, directing, and coordinating medical and health services as the primary responsibilities of middle managers. Middle managers might manage an entire facility or specialize in managing a specific clinical area or department, or manage a medical practice for a group of physicians. Typically they work to improve efficiency and quality in delivering healthcare services; stay current with new laws and regulations for compliance; supervise assistant administrators in large facilities and manage finances such as patient fees and billing. Middle managers also create and monitor work Journal of Management Development Vol. 35 No. 9, 2016 pp. 1149-1162 © Emerald Group Publishing Limited 0262-1711 DOI 10.1108/JMD-12-2015-0173 Received 8 December 2015 Revised 1 June 2016 Accepted 31 July 2016 The current issue and full text archive of this journal is available on Emerald Insight at:

www.emeraldinsight.com/0262-1711.htm 1149 Middle managers in healthcare organizations schedules and represent the facility at investor meetings or on governing boards.

They keep records of the facility’s services such as number of inpatient beds used; as well as communicate with members of the medical staff and department heads (Bureau of Labor Statistics, 2016).

Nevertheless, many middle managers,having reported feelings of being underappreciated, typically point to the lack of information or poor communication from senior executives (Belasen, 2014). Studies show that middle managers operate within the realm of difficult policies, procedures, and guidelines (Morris and Upchurch, 2012), and without a consistent flow of communication from the top, are often left unsure of what is required of them (Dance, 2011). Currie (2006) describes middle managers in healthcare settings as reluctant but resourceful individuals operating at the junction of top-down and bottom-up predicaments with the constant need to revalidate their worthiness. Middle managers have been perceived as intermediaries that impede organizational efficiency (Embertson, 2006) such that some scholars have pondered whether or not middle managers are necessary within an organizational structure (Hamel, 2011).

Have middle managers’roles been undervalued as top executives are prepared to handle the new healthcare regulatory requirements (Belasenet al., 2015)?

Are healthcare middle management roles still tenable? Are they well regarded and targeted for succession planning? Are middle managers in healthcare organizations well prepared for new structural challenges? Insufficient middle manager development could lead to the risk of burnout, rising turnover costs as well as and undermining succession planning. Reportedly, higher turnover rates among middle managers might also weaken organizational performance and diminish the vital connection between strategy thinking and planning and implementation (McKinneyet al., 2013).

In this paper we discuss the significant role of middle managers in healthcare organizations operating in environments of change, the importance of recognizing the conditions leading to low morale, and the rising costs of turnover and leadership discontinuity in healthcare organizations. We then address the need for building a strong talent pipeline through middle manager development.

Roles and skills According to the Bureau of Labor Statistics (2016), as of 2014-2015, middle management has made up 7.6 percent of the US workforce, which has equated to roughly 10.8 million managers. In the healthcare industry, the 333,000 middle managers are an important part of the organizational resources, with most working in state, local, and private hospitals (39 percent); ambulatory healthcare services (26 percent); group medical services and outpatient healthcare centers (16 percent); nursing and residential care facilities (11 percent); and government (8 percent).

Employment of medical and health services managers is projected to grow by 17 percent from 2014 to 2024, much faster than the average for all occupations.

The median annual wage for medical and health services managers was $94,500 by mid-2015. Most medical and health services managers work in offices in healthcare facilities, including hospitals and nursing homes, and group medical practices.

In hospitals, for example, middle managers convert strategic goals into actionable improvement plans at the department or work unit level, engage employees in safety and quality assurance efforts through CQI and Kaizen, and identify processes for continuous improvement. A sample of these roles appears in Table I. Middle managers act like a resource to first line supervisors and peer managers and are on the lookout for 1150 JMD 35,9 tradeoffs that often escape the attention of senior executives and that are essential for the performance of the organization (Osterman, 2009). They use a variety of channels to respond to questions, give feedback, and help increase employee satisfaction (Madlock, 2008).

Some scholars would liken a middle manager’s responsibilities to those of a strategist or change architect who facilitates the communication about corporate thought, action, and results (Pappaset al., 2004; Wooldridgeet al., 2008). Middle managers with active involvement in the strategy process have been found to demonstrate higher levels of commitment to organizational goals and contribute to the success of strategic initiatives (Beck and Plowman, 2009; Huy, 2001; Vila and Canales, 2008). Furthermore, evidence suggests that middle managers’upward leadership and downward influence appear to affect the alignment of organizational activities within the strategic context. They instigate change in communications with executives and help implement innovation in interactions with lower levels (Belasen and Rufer, 2013; Floyd and Lane, 2000; Rouleau and Balogun, 2011).

A variety of healthcare occupations bring with them different cultures and communication practices that must be bridged and mobilized from the middle-out for optimal operations. Middle managers make substantial qualitative and quantitative contributions to their organizations, and have the know-how to move work forward with tact and velocity. They understand the complexity of their work environment and feel energized by being the conduit between corporate thought, action, and outcomes (Haneberg, 2010). As a result, they are able to provide much richer views to problem solving communication with diverse insights. Middle managers are centrally located within the chain of command and typically perform or directly influence three important tasks: first, technical tasks linked to the operating core, routines, and compliance; second, people tasks involving leading frontline teams, motivating, and guiding employees; and; third, strategic tasks associated with financial reports, analysis of continuous improvement projects and participation on boardroom discussions (Belasenet al., 2015). They work to accomplish core tasks and ensure continuity, keep the organization going and attain positive organizational outcomes.

Middle managers implement strategy, translate goals from executive level to lower levels, create local relevance, interpret shifting contexts, clarify words and actions of executives, and promote organizational discourse. A sample of their skills and abilities appears in Table II.

Nursing home administratorsManage staff, admissions, finances, facilities and care of residents in nursing homes Clinical managers Oversee specific departments, such as nursing, surgery, or physical therapy, with responsibilities based on the particular specialty. Clinical managers set and carry out policies, goals, and procedures for their departments, evaluate the quality of work processes and write reports and budgets Health information managersResponsible for the maintenance and security of patient records. They must stay up to date with evolving information technology, current and proposed laws concerning health information systems. Health information managers must also ensure that databases are complete, accurate, and accessible only to authorized personnel Assistant administratorsWork under senior executives in larger facilities and often handle routine decisions. They also direct activities in clinical areas such as nursing, surgery, therapy, medical records, or health information Source:www.bls.gov/ooh/management/medical-and-health-services-managers.htm#tab-2 Table I.

Roles and responsibilities 1151 Middle managers in healthcare organizations Middle managers’central position within the hierarchy reinforces their mediation roles in interpreting critical events and creating shared meaning (Beck and Plowman, 2009).

As opinion leaders within the communication network of healthcare settings (Pappas et al., 2004; Valentino, 2004), they also act as“sense-makers”to frontline employees (Rouleau and Balogun, 2011). They balance competing commitments for change and continuity (Vilkinas and Cartan, 2006), provide structure and direction and react to the emotional needs of employees for consistency, dependability, and clarity (Belasen and Frank, 2010). Middle managers’duality of operating experience and proximity to decision makers make their“clutch roles”during transitions critical for organizational success.

They search for new opportunities, evaluate the merits of strategic initiatives and propose new projects (Mantere, 2008). In healthcare organizations, middle managers make significant contributions across the healthcare organization in their roles of entrepreneur, communicator, therapist, and stabilizer (Embertson, 2006).

A crack in the armor The Affordable Care Act (ACA) has fueled a large number of mergers within the healthcare industry as it altered the way insurance companies reimburse healthcare providers and the drive toward more efficient outpatient. Simultaneously, we are seeing significant convergence across industry sectors, blurring the lines between payers and providers (Woodson, 2015) as most integration occurs clinically or financially, horizontally or vertically, and the relationships can range from loose affiliations to complete mergers (American Hospital Association, 2014). The results have been notable: 105 deals were initiated in 2012 alone, up from 50 to 60 annually in the pre- ACA years (Wall Street Journal, 2013). This number jumped to 140 in 2014 (Gamble and Sachs, 2015). The report of Moody’s (2015) on healthcare trends also projects a continued consolidation in the healthcare industry in 2016 and beyond.

To meet the new challenges hospitals have been re-instituting reforms and structural changes including team-based design, inter-professional collaboration, and shared leadership that worked well in the past (Alvesson and Sveningsson, 2003).

Shared leadership in healthcare organizations and other contexts is well documented in the current literature (Chreimet al., 2010; Deniset al., 2010). These changes, however, were needed primarily in response to integration challenges at the operational level since work units in healthcare are particularly specialized with little opportunity for organizational synergy (Gilmartin and D’Aunno, 2007; Tucker and Edmondson, 2003).

Analytical and adaptation skillsEnable understanding of current regulations, new or proposed policies Communication skills Help facilitate exchanges with executives, peer managers and health professionals Detail oriented Allow middle managers to organize and maintain scheduling and billing information for very large facilities such as hospitals Interpersonal skills Support effective communication with physicians, staff, and patients; Problem solving Provide creative solutions to staffing or other administrative problems; Innovation Source of innovation and the ability to respond to stakeholder expectations.

Technical skills Keep currency with advances in healthcare technology and familiarity with coding and classification software and electronic health record (EHR) systems as facilities adopt these technologies Source:www.bls.gov/ooh/management/medical-and-health-services-managers.htm#tab-4 Table II.

Skills and abilities 1152 JMD 35,9 At the same time, healthcare units and teams operate in environments that are largely influenced by broader institutional goals (Finnet al., 2010) where middle managers are most needed for guiding and directing frontline teams to carry out the mission (Shaw, 2005). Yet, detractors have continued to call for the elimination of middle management through delayering (Hamel, 2011).

Delayering by which senior executives become directly connected with lower levels has the dual effect of increasing executive span and decreasing depth through functional centralization. Evidence suggests that the number of managers reporting directly to the CEO has increased steadily from an average of 4.4 in 1986 to 8.2 in 1998 (Rajan and Wulf, 2006). At the same time, the number of positions between the CEO and department managers (or division heads) has decreased by more than 25 percent.

These trends have dominated non-medical industry Fortune 500 companies as well (Neilson and Wulf, 2012). While the elimination of middle management layers has pushed some decision making down to the frontlines and provided companies greater flexibility in responding to customers, research shows that the addition of senior executives (e.g. finance, legal, marketing, R&D) and corporate staff roles to the C-suite added to the CEO’s span of control and shifted decision making power up, not down (Guadalupeet al., 2012).

In hospital settings and health systems, frustrated middle managers react to their loss of autonomy by sliding out to isolated, out-of-reach positions, in effect choosing an avoidance strategy (Garcia, 2006). Unable to handle cross-over pressures, they tend to stay away or lay low, fueling the image of“uncommitted managers”(Carlstrom, 2012).

Behavioral economists suggested that the most basic human desires are meaningful validation and appreciation, the key drivers for work motivation (Ariely et al., 2008).

Rather than providing them assurances, hospital administrators react harshly by typecasting middle managers as abdicators or low performers that must be further avoided or by-passed. When their valuable contributions go unnoticed by senior executives who frequently favor a non-affective task focus (Huy, 2011), middle managers experience negative feelings of“forgotten practitioners”(Hayes, 2005). The constant pressure on middle managers to focus on daily routines away from strategic circles places them in sink-or-swim predicaments creating the impression that middle management is an occupation whose autonomy is largely constrained (Osterman, 2009).

Having the dreadful task of absorbing the discontent of upper and lower levels yet without much decision-making authority, middle managers tend to internalize failure and suffer higher rates of depressive symptoms and anxiety than those at the top or bottom. Symptoms of depression were reported by 18 percent of the supervisors and managers compared to 12 percent for employees (Prinset al., 2015). Occupying what the researchers labeled“contradictory-class location,”middle managers are expected to enforce strategic policies from the top–ones they did not develop–on subordinates who might object to those new policies. They feel increasingly isolated from the management team, lose confidence in their judgmental abilities and, uncertain about their future–respond by shifting commitments. It is the diminished role in decision making, the freedom to determine“how to get there,”the making of the decision, not the execution, that is demoralizing (Belasen, 2014).

Trapped, stressed, and unappreciated The way executives relate to their middle managers is subtly influenced by what they expect of them. If their perceptions of mediocrity lead to setting up low expectations, the productivity of the affected middle managers is likely to be perceived as poor, 1153 Middle managers in healthcare organizations which in turn reinforces that initial perception of unmotivated middle managers (Belasen and Fortunato, 2013). They are perceived as mediocre or weak performers who tend to live down to the low expectations that senior executives have set out for them, in effect perpetuating a vicious cycle of perceived incompetence (Manzoni and Barsoux, 2002). This self-reinforcing process, prime for conditions of failure, is also known as the Pygmalion effect (Livingston, 1969). Pygmalion refers to a person who consciously or unconsciously is aware of an expectation and acts in a way that is consistent with that expectation. When the emotional impact of the work middle managers perform is not acknowledged, they further feel lonely, unhappy and abandoned (Kuyvenhoven and Buss, 2011). More than two decades ago Jackson and Humble (1994) observed similar behavioral responses:“As steep hierarchies have flattened, opportunities for promotion have disappeared; many remaining middle managers feel cheated and trapped”(p. 17).

Zenger and Folkman (2014) examined the demographic characteristics of unhappy employees among more than 320,000 individuals in a variety of organizations and found that 16,000 (5 percent) were middle managers. The main sources of unhappiness included poor leadership as the number one reason followed by“no career or promotion opportunities,”“work lacks meaning and purpose,”“being treated unfairly compared with others,”“feeling under-appreciated,”“overworked,”and“viewing the organization as inefficient and ineffective.”For healthcare organizations with fairly narrow profit margins–turning that 5 percent around could have a dramatic effect on the bottom line –especially since 48 percent of the middle managers reported that they plan to leave their current jobs in two years or less (McKinneyet al., 2013). Deloitte Consulting LLP (2014) reports that 79 percent of business and HR leaders worldwide believe they have significant retention and engagement issues.

Becoming hypereffective Conscious about the likelihood of being eliminated, demoted, or by-passed, surviving or hopeful middle managers attempt to“prove their premium”by working excessively hard, becoming hypereffective (Belasen, 2012). Pressure to increase hours at work comes from the need to perform their roles better but also from the need to pick up the slack left from those who remained uninvolved or were let go. On the surface, hypereffective managers appear more productive and with a greater desire to achieve organizational goals. However, a great deal of personal time is lost in order to maintain or achieve the goals of the organization, often leading to role tension and cognitive dissonance (McConville, 2006). There is a tradeoff in that hypereffective managers find fewer opportunities to diminish the performance of some roles in order to increase their attention to other roles (Belasen and Frank, 2004).

Hypereffectivity may sound good as it tends to transform middle managers into conservative and overworked managers who are pushed to the limits by the expectations of those above them who demand nothing short of better results.

However, the pattern of change in the tasks and responsibilities underlying the roles performed by hypereffective managers suggests a severe loss of discretionary time and an increase in the sense of powerlessness (Belasenet al., 1996). Interviews with surviving middle managers by these authors revealed that they work more and produce more with the same pay, often without recognition. Others have inherited more tasks and greater responsibilities that require monitoring, not necessarily decision making (Belasenet al., 2015). As discussed below, added responsibilities coupled with insufficient middle manager development lead to burnout and higher rates of turnover which subsequently undermine succession planning. 1154 JMD 35,9 The dual challenge of transition and turnover Turnover can cost a hospital as much as 5.8 percent in lost revenues with turnover among middle managers accounting for as much as 34 percent of those losses (Waldmanet al., 2004). According to the American Hospital Association (2013) the percentage of hospitals with negative operating margins in 2011 was 30.5 percent.

By concentrating on reducing turnover an organization could possibly improve its operating margin. The healthcare industry is growing and the need for healthcare managers is expanding so hospitals and other healthcare organizations will be competing over the same human capital resources. In fact, employment of medical and health services managers in the USA is estimated to grow 23 percent by 2022, much faster than the average in other sectors. To reduce turnover, executives must build a culture of trust and employability, revamp middle manager development programs and promote from within. Are executives prepared for these challenges?

Prior to the massive consolidation in the healthcare industry in 2013-2016, healthcare CEOs were delaying their departure from their posts with 54 percent indicating that they have no plans to retire any time soon despite the fact that 73 percent of them are between the ages of 55-62 and 24 percent are age 63 or above (Witt Kieffer, 2012). Over 51 percent of the surveyed CEOs by Witt Kieffer (2012) indicated that they have worked with the senior management team to identify potential successors; 39 percent have developed a formal planning process with their boards; 34 percent mentored their successors; and 29 percent have identified a successor to step into their roles. At the same time, 63 percent claimed that they are“too young”to retire.

While they understand the importance of grooming the next successor, they do not see this as an urgent matter. Meanwhile, overburdened and undertrained middle managers have been on the verge of burning out, just as they were being considered for fewer senior leadership roles (McKinneyet al., 2013).

Recently, however, the movement of hospital CEOs out of their positions has begun to shift. Challenger, Gray & Christmas, Inc. (2015) survey found that of the 1,246 CEO changes in 2013, healthcare led the way with 265 departures. In 2014 the number of announced departures jumped to 294, an increase of 10.9 percent. In 2015, out of the 230 CEO departures in the healthcare industry, 137 CEOs stepped down from their hospital positions. As CEOs exited the workforce, the problem of how and who will fill the gaps left behind became even more acute as many organizations were unprepared to handle these departures systematically.

With rising CEO turnover rates, hospitals need to develop adequate succession programs to identify and train new leaders. Moreover, these programs should build a strong talent pipeline with those already working within the organization, especially since it costs less to develop and retain a cadre of leaders in-house than to hire and train new managers (Dubeet al., 2010).

Grooming middle managers for senior leadership positions makes sense. Middle managers who are appreciated and are also targeted for upward mobility are more satisfied, productive, and committed. This aligns well with senior executives’goal to reduce the financial burden of turnover (Coyneet al., 2010). Additional mitigated costs are opportunity costs, e.g., retraining replacement employees and by-product costs, e.g., adverse patient outcomes and low energy levels often exhibited by staff during stressful situations.

Value in the middle Birkenet al.(2012) sought to identify the relative contribution of middle managers to innovation-related outcomes and found that their influence on employees was 1155 Middle managers in healthcare organizations positively related to outcomes of effectiveness, competitive positioning, operating efficiency, and financial performance. Variation in healthcare quality was related to either circumvention of middle managers or poor communication of key strategic and clinical information across sites, units, and teams. Mollick (2012) found that it was middle managers, rather than innovators or organizational strategies, who best explain variation in firm performance. Managers accounted for 22.3 percent of the variation in revenue among projects, as compared to just over 7 percent explained by innovators and 21.3 percent accounted by organizational strategy. Even in a young industry that rewards creative and innovative products; innovative roles explain far less variation in firm performance than do managers.

While innovators may come up with new ideas and concepts, middle managers play a critical role in determining which ideas are given priority and support (Belasen and Rufer, 2013). The lack of proper presence of middle management in innovation implementation can stymie hospital turnaround (Freed, 2005), especially since middle managers help remove barriers to problem solving, stimulate innovation and execute strategic change (Currie, 2006). Another study found that while the majority of the change efforts failed – the hallmark of the successful 32 percent was the involvement of mid-level managers two or more levels below the CEO (Tabrizi, 2014). Pearceet al.

(2009) found that while the leadership of CEOs is of enormous importance, the truly high performing organizations are the ones led by teams. Our experience shows that in hospitals middle managers have been able to shift from team builder to team leader and effectively initiate inter-professional collaborative efforts (Belasen, 2013).

Discussion and conclusions Research has shown that healthcare management practices are founded on a culture and tradition of hierarchical hospital leadership. Conversely, successful strategic implementation in healthcare organizations is mostly the result of interfunctional collaboration and effective middle management (Belasen, 2014; Skela and Pagon, 2008).

Unfortunately, the inclusion of middle managers in leadership development and succession planning has been found to be extremely poor. As discussed earlier, healthcare executives are not placing enough emphasis on cultivating the next cadre of leaders that will be required to sustain competitive advantage and business continuity.

Often the importance of involvement in decision making and strategizing is taken for granted by top executives who leave overwhelmed middle managers, tied to tasks and operational issues, without the ability to step forward and exhibit their stronger strategizing skills (Lam, 2015). The feelings of being undervalued or unappreciated can be carried over and lead to anxiety and depression or even to the hypereffective conundrum discussed above.

Embertson (2006) argued that the role of middle managers in strategic formulation and implementation has largely been overlooked and makes a strong and compelling case for effective middle management development in healthcare organizations.

Well-designed leadership development programs and succession planning along with willingness by senior executives to acknowledge the“value in the middle”and promote from within can create the pathways to bridging the leadership gap in healthcare organizations. These observations point to a critical area where succession planning practices can and should be improved–the CEO and the board need to initiate the selection of internal candidates and ensure their preparation to lead and manage organizational transitions (Belasenet al., 2015). Senior executives should set out realistic expectations that lead to positive outcomes and that are relevant for middle 1156 JMD 35,9 managers (Alvarez, 2007; McGurk, 2010). It is important, however, that middle managers communicate their indispensability to senior executives (Zengeret al., 2011).

They need to take the vision and goals of organizational leadership and cascade them appropriately so that frontline teams are aligned with that vision.

Davenport and Harding (2010) recommended that middle managers become“off-stage managers”who focus on managing the environment, not the people. The off-stage manager creates an enabling and empowering environment where frontline teams and employees are entrusted with discretionary power to identify issues and solutions.

Similarly, Kelly and Nadler (2007) suggested that middle managers should shift their focus to influencing processes and decisions, rather than controlling them. Sliding up to a governance role or down to an advocacy role, for example, could allow middle managers to use their repertoire of roles flexibly, especially during organizational change (Hales, 2006). Giving value to middle managers, as well as any employees, is one of the keys to inspire people, increase their performance and improve their leadership capacity.

Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies could lead to a drastic change of the current perception of the importance of middle managers as well as lead to a long-term retention, well-being and benefits for both the organization and its employees.

Directions for future research Raelin and Cataldo (2011) found that middle management represents a highly relevant case to investigate a variety of organizational situations where a lack of empowering interface was an important factor in the failure of change implementation. We believe that this failure could be also viewed as cause or consequence of the reduction of the middle managers autonomy and control and therefore should be the subject of further research. Pink (2009), for example, argued that intrinsic motivation needs to take a prominent role in communicating and motivating employees, with a focus on giving them more autonomy, more opportunities for mastery, and to build consensus around organizational purpose. Both longitudinal and cross-sectional studies can help evaluate the overall effects of bypassing middle managers on organizational performance.

Studies can also be designed to evaluate the ways by which healthcare CEOs and their boards initiate the internal selection of successors to ensure leadership continuity, support the development of middle managers, and respond effectively to strategic and structural challenges.

Belasen and Frank (2010) confirmed the existence of primary message orientations used by managers with those reporting to them. They also quantified the extent of the shift of message orientations in environments of change. An interesting area of research could involve the message orientations used specifically between senior executives and middle managers with the goal of demonstrating the importance of middle management.

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About the authors Alan Belasen, PhD, led the design and implementation of the SUNY/ESC MBA in Management, MBA in Global Leadership, MBA in Healthcare Leadership and the MBA Pathway for Veterans, which he chaired between 2004 and 2015. Dr Belasen received the Outstanding Reviewer Award 1161 Middle managers in healthcare organizations from AOM, Management Education and Development, five times. He is also the 2014-2015 recipient of the SUNY Chancellor’s Award for Excellence in Scholarship and Creative Activities.

Dr Belasen has provided training and development to hundreds of managers and executives in various industries and organizations. He is the author of five books, most recently:Mastering Leadership, Jones & Bartlett Learning, 2015. Alan Belasen is the corresponding author and can be contacted at: alan.belasen@esc.edu Ariel R. Belasen, PhD, is an Associate Professor of Economics and Finance at Southern Illinois University Edwardsville. For the past decade he has been conducting research on human development and anti-corruption endeavors as well as on disaster recovery efforts. Dr Belasen’s work has resulted in dozens of conference papers, book chapters, and journal articles published in American Economic Review,Journal of Human Resources, and Intelligence, among others.

Dr Belasen has provided management consulting to healthcare and business organizations in the areas of performance optimization and project management.

For instructions on how to order reprints of this article, please visit our website:

www.emeraldgrouppublishing.com/licensing/reprints.htm Or contact us for further details:permissions@emeraldinsight.com 1162 JMD 35,9

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