Abstract
BackgroundMuch of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management’s perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. The aim of this study was to assess middle managers’ behaviors to enforce a new national smoke-free hospital campus ban, to evaluate their perceptions of the level of compliance of the new regulation, and to explore their attitudes towards how smoking affects the work environment.MethodsWe used a cross-sectional survey, conducted online to evaluate middle managers of a general hospital in Catalonia, Spain. Close-ended and open-ended questions were included. Results were analyzed by using quantitative and qualitative methods. The managers’ open opinions to the proposed topics were assessed using UCINET, and a graph was generated in NetDraw.ResultsSixty-three of the invited managers (78.7 %) participated in the survey. 87.2 % of them agreed that the hospital complied with the smoke-free campus ban and 79.0 % agreed that managers have an important role in enforcing the ban. They also perceived that smoking disturbs the dynamics of work, is a cause of conflict between smokers and non-smokers, and harms both the professional and the organization images. However, 96.8 % of respondents have never given out fines or similar measures and their active role in reminding others of the policy was limited; in addition, 68.2 % considered that hospitals should provide tobacco cessation treatments. Smoker middle managers were more likely than non-smokers to perceive that smoking has little impact on work.ConclusionsMiddle managers play a limited role in controlling tobacco consumption; smokers are less prone to think that smoking disturbs work dynamics than non-smokers. Tailored training and clear proceedings for middle managers could encourage more active roles.
Highlights
Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management’s perspectives
About 73.0 % of middle managers agreed that health providers should know how to assist smokers, 68.2 % considered that hospitals should provide tobacco cessation treatments, and 62.9 % considered that it is one of the duties of top managers to allocate resources for tobacco control (Table 2)
(a) the behaviors assumed by middle managers were limited and they infrequently reminded others about the policy, encouraged smokers to quit and, solved conflicts related to smoking in the hospital; with certain reticence in some cases
Summary
Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management’s perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. Health care organizations frequently face new challenges such as the implementation of policy innovations. Research has identified that effective implementation depends on the commitment of top managers, internal communication of the project, the organization’s support activities — i.e. training, resources, presentations, and meetings —, and the willingness of individuals, mainly health care providers to implement these activities on the frontlines [12, 13]. A team work approach with a pivotal middle manager has become popular in healthcare organizations; there is increasing potential for middle managers to influence the implementation process [13]
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