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MIDDLE LEVEL MANAGERS, INFLUENCE AND STRATEGY PROCESS: Abstract: Strategy is centrally concerned with the process of how

firms respond to and exploit environmental signals( Mintzberg 1979).Although the filed of business policy was built on the classical process studies of Chandler (1962); looked at strategic initiatives as a multi level process ,but his emphasis on the role of top management (Burgelman 1983) laid the foundation for dominance of research on issues faced by top management (Floyd and Woolridge 2000).This has led the discipline to look at strategy as distinct formulation and implementation with emphasis on content and implementation as assured. The result is that even today there is no convincing explanation as how some firms are able to achieve superior performance over time (Joyce2005). Of late there is an attempt to look at the role of middle level managers in the strategy process (Balogun 2003; Howell et al 2006) but they are sporadic and fragmented. There is still lacking, a comprehensive look at the role of middle level managers and its linkage to firm performance. Competitive advantage is built thorough generation and deployment of capabilities over time and generation of capabilities is crucially dependent upon the role of middle level managers. The middle management is defined as managers in the second and third level of hierarchy and those who are not reporting directly to the CEO (Floyd and Woolridge 1992). Traditionally middle level managers were given the role of executors of a calculated formal strategy that was articulated in detailed plans. This required the use of authority and influence to some extent. The realities of todays business requires a reorientation of the roles of middle level managers towards management of relationships, finding innovation, creating a mind set and facilitating learning(Floyd and Woolridge 1997, 2000). This change in orientation accentuates the importance of use of influence as a mechanism to motivate and obtain commitment from operating staff while simultaneously reducing the role of authority. This paper articulates the central proposition that differences in performance of middle level managers is contingent upon their effective use of influence to maintain staff commitment. The paper first builds the conceptual basis for this proposition, and then describes the context in which the proposition is to be tested. After the methodology and results; the paper discusses the role of influence and its linkage to the results. Finally it outlines limitations of the study and identifies some options for future research.

INTRODUCTION: Strategy as a field of enquiry developed from a practical need to understand reasons for success and failure among organizations. This led to a focus on overall performance and on the top management. The works of Chandler (1962) and Andrews (1971) created a view that strategy is made at the top and executed at the bottom, further reinforcing the fields focus on the top management while implementation was seen as secondary (Floyd and Woolridge 1996) The emergence of corporate planning in the 1970s further heightened the disconnect between formulation and implementation, as operating decisions were made as if plans did not exist. Key insight was that plans were ineffective and line managers needed to be involved in the process (Floyd and Woolridge 2000).The development of analytical tools like BCG, PIMS further reinforced the notion that strategy was an exclusive top management function. The development of the strategic management paradigm delineated the formulation and implementation components of strategy, identified roles for all mangers except the lowest operating level in the formulation process. Implementation was design of standards, measures, incentives, rewards, penalties, and controls (Floyd and Woolridge 1996). Managers were thought to be more as obstacles. It was Mintzberg and Waters (1985) whose view that strategy is a pattern in a stream of decisions, that expanded the role of other than the top management in strategy making since strategies could be emergent. Burgelman (1983c) integrated both the top down and bottom up view of strategy by introducing the concept of autonomous development of strategy in addition to the normal intended strategy, reinforcing the observations of Bower(1970) who stated that the top management had little control on what projects get pushed for approval. These put the role of middle level managers in the correct perspective. The middle level managers are located between the strategic apex and the operating core. Irrespective of their location, their distinguishing function is to align the organisational goals and strategies with its operating levels (Floyd and Woolridge 1996). Traditionally middle level managers were given the role of executors of a calculated formal strategy that was articulated in detailed plans. This role was appropriate for a period up to the 1970s, where the emphasis was on meeting an expanding demand for goods. With the growth of middle level managers in the post world war 2 eras, there was also the rise of the management schools which was an attempt to professionalize the burgeoning cadre of middle level managers

and thus creating a distinction from the rest of the members of the organisation. They personified commitment and were the core of corporate strength (Floyd and Woolridge 1996). With increasing pace of change in todays business environment due to globalization of competition, demanding customers and rapidly changing technologies, the role of middle level managers has shifted to supporting the top managements vision by developing and promoting initiatives that respond to changing conditions (Floyd and Woolridge 2000). The changing orientation of middle management work (adapted from Floyd and Woolridge 1996) can be represented as follows: Traditional orientation Developing coordination within Present orientation Boundary spanning( relationships across

functional boundaries boundaries) Controlling growth Finding innovation( championing) Executing plans Synthesizing information Applying new technologies to production Facilitating learning (transferring technology). This reorientation is as a result of trends to outsource due to emphasis on doing only core activities, increase in the services components of business, increased emphasis on relationships in business as a means to achieve competitive advantage, changing customer characteristics, and increased competition resulting in an emphasis on strategic understanding instead of planning. The increased use of technology at all levels of the organisation increases the work role of middle level managers as they have to identify methods of taking advantage of technology (Floyd and Woolridge 2000). Thus the realities of todays business requires a reorientation of the roles of middle level managers towards management of relationships, finding innovation, creating a mind set and facilitating learning(Floyd and Woolridge 1997, 2000). THE ROLE OF THE MIDDLE LEVEL MANAGER The four crucial roles of the middle manager (Floyd and Woolridge 1992, 1996) have been identified as; 1. Synthesizing information (sense making)the position of centrality in the organisational information network facilitates his ability to synthesize (attend, frame and diagnose issues) information and influence both the operational level and top management perceptions.


Facilitating adaptability(sense making and sense giving ): Middle level managers

facilitate generation of variant behavior, cooperation and help in stimulating experimentation leading to innovation, which can then lead to new strategic initiatives 3. Championing strategic alternatives (issue selling) -- this arises form their unique position in the middle of the organisation and as a linking pin to bring entrepreneurial and innovative proposals to the notice of the top management. This is after they have screened 4. the information, got informal cooperation, provided resources for experimentation and established feasibility of the proposal. Implementing deliberate strategy (sense giving): They also translate strategic plans into operational plans and facilitate implementation of change. The middle level managers are at the nexus of social interactions, act as a node in a network of communications, connect flow of information from top to operating level and vice versa, and integrate these communications. Thus they are in a position to appreciate the firms strategic requirement. The middle level managers are in a position to know the availability and depth of capabilities in an organisation and thus can help in synchronizing strategic plans with reality. Their interaction with the customers gives them an idea of the market requirements enabling them to adapt capabilities to service these needs. This is enabled by their ability to translate customer needs to requirement of product characteristics, in the process creating knowledge. By their very position as a linking pin between top management and operational level, they act to supply feed back to the top management which facilitates adjustments in the strategic plans. Capability based competition forces managerial knowledge to be placed at the centre of strategic planning which brings to fore the role of middle level managers by virtue of their centrality in the organisational information network and their ability to promote organisational learning. The effective execution and integration of all these roles is what results in superior firm performance (Floyd and Woolridge 1992, 1997)(see figure 1). The most crucial activities thus are sense making, sense giving and issue selling (Dutton and Ashford 1993). Sense making is comprehension and issue diagnosis and facilitates issue selling as upward influence tactics and sense giving as downward influence tactics (Dutton et al 2001). Strategic sense making and sense giving are defined (Gioia and Chittipeddi 1991; Gioia and Thomas 1996; Thomas et al 1993, 1994) as two complimentary and reciprocal processes. Sense making is the way managers understand, interpret and make sense out of information

surrounding strategic change. Sense giving is the attempts to influence the outcomes through communication of thoughts and thus gain support. Sense making involves noticing, framing and diagnosis of an issue. Adapted from Floyd and Woolridge 1992, 1996 Deliberate strategies Implementation Deployment of capabilities Facilitating Incorpora tion Envir onme nt Synthesizing Accumulation of new capabilities Championing FIGURE 1 Shared strategic understanding Incorporation in capability set of firm Performance

Emergent strategies

Through the processes of sense making, sense giving and issue selling the middle level managers are able to determine their involvement in organisational strategic issues and exert influence to facilitate acceptance of their supported initiatives. The combination of involvement and influence (both upward and downward) results in the four roles they are credited withsynthesizing (sense making and sense giving); facilitating (sense making and sense giving); championing (sense giving and issue selling) and implementing ( sense giving).


Organisations can be seen as interpretation systems (Weick 1979) or as complex adaptive systems with dispersed controls, multiple integrated levels of building blocks and members acting consistent with their expectations (Floyd and Woolridge 2000) or as social systems consisting of patterned recurring relationships among individuals whose roles are linked by networks transmitting information, affect and influence. In these views; people organize themselves to make sense of the inputs and enact them back to make order out of the world

(Weick and Sutcliffe 2005). Organisational sense making can be seen as organizing through communication in a social community where know how and information combine into knowledge and adaptability depends upon the speed and efficiency of creation and transfer of knowledge (Kogut and Zander 1996).The recombination of this knowledge allows evolution of capabilities (Kogut and Zander 1992) which organisations make use to exploit opportunities present in the environment. Organisation attention, sense making and knowledge generation through involvement and influence of members determines organisational performance. In an organisation; top management mediates between the organisation and capital markets to maintain economic discipline and take care of stakeholders interests; core transforms inputs into outputs and the middle management, who have the largest connections, hold the organisation together transferring knowledge and influence (Floyd and Woolridge 2000). It highlights the criticality of the role of middle management which is influenced very much by the context in which they operate. Factors which influence their performance can be categorized into individual and organisational factors. INDIVIDUAL FACTORS These are the factors which determine the ability of the middle level manager to show involvement and use influence in the performance of his work related activities. The ability to influence is influenced by an individuals educational background, his functional experience and the diversity of his experience (hambrick 2005). Personality traits like N-ACH (need for achievement), internal locus of control, personal initiative and persistence influence the ability of a manger to exercise and use influence (miller and droge 1986; frese and Fay 2001). These individual characteristics increase the cognitive ability of the manager, improve his communication skills and give him a greater understanding and awareness of the organisational context which facilitates the successful use of influence. ORGANISATIONAL FACTORS: Organisation al factors such as organisational strategy, absorptive capacity (Cohen and levinthal 1990), communication and information processing systems (Dollinger 1984), knowledge systems (Nonaka 1994) create the context in which the influence is exercised. They give meaning and substance to the influence tactics of managers. The influence tactics are part of the activities of the middle level managers.

THE OUTPUT OF MIDDLE MANAGERS: Floyd and Woolridge (1992) identified the four main activities of the middle level managers as synthesizing, facilitating, championing and implementation. Success in these activities leads to effective development and deployment of organisational capabilities leading to superior firm performance (Floyd and Woolridge 2000). Middle level mangers when synthesizing create strategic meaning out of operating and strategic information; share this information thereby facilitating integration of new knowledge and thus development of knowledge base. When facilitating they nurture and develop experimental programs and organisational elements that increase organisational flexibility; encourage organisational learning and expand the range of firms strategic response (Floyd and Woolridge 1996). When championing they attempt to provide the firm with new capabilities or allow firm to use existing capabilities differently. When implementing they align organisational action with strategic intent. In these activities they are facilitated by their individual capabilities which facilitate their involvement and influence subject to the moderation of the organisational factors. INFLUENCE AND INFLUENCE TACTICS: Power, influence and political behavior are constantly encountered in organisations. Traditionally influence has been linked to role of hierarchical authority and bureaucratic rationality (Mowday 1978). The ability to influence decisions is both a function of formal position and non formal attempts. Therefore the role of power and influence assume importance. Authority refers to legitimate power based on formal position. Power and influence refer to a generalized ability to change the actions of others in some intended fashion (Mowday 1978). Influence tactics are mechanisms used to influence people. They have been categorized as soft which does not entail use of formal authority and as hard where formal authority and coercion is used. Soft tactics are ingratiation, consultation, inspirational and personal appeals and rational persuasion while hard tactics are pressure, legitimizing or coercion (Falbe and Yukl 1992). Managerial performance is significantly influenced by his success in influencing people. Influence can lead to continued commitment and extra effort from subordinates; successful implementation of policies and strategies (Nutt 1987); obtaining cooperation and support from colleagues and adoption of innovations (Falbe and Yukl 1992). Use of soft tactics and in combination has been found to result in greater successful outcomes than hard tactics

Influence attempts can result in commitment, compliance and resistance. Commitment is indicated by exercise of initiative and persistent effort to do the task. Compliance is an effort to carry out the task but makes only average effort while resistance is seen when there is avoidance of effort to carry out the task (Falbe and Yukl 1992). Thus Managerial performance is a result of interaction of individual abilities utilized in an organisational context to generate activities which are in line with the organisational expectations. The whole model can be depicted as in figure 2 THE CONTEXT: Literature states that number of contextual and individual factors determine the choice of influence tactics and its effectiveness. Some of them are relative power of the parties; direction and objective of the influence attempt, political skill of individual and the choice of tactic itself (Higgins et al 2003). The choice of the context should facilitate the observation of these factors and give scope to the managers to exercise them. The health care service context offers such an opportunity. Health care is defined as the activities and means used to prevent or cure morbidity arising out of different processes. Health services can be delivered as close to the client system which covers population based preventive services, primary health care services and first level referral care. Primary health services constitute of essential health care made universally accessible to all through their participation. They can also be delivered through specific disease centric programmes delivered in project mode through specifically constituted agency. Health care as a service is one of the factors which influence the health of an individual. Risk and uncertainty are special features of health care service and are responsible for all of the special characteristics of the service. The special characteristics include an irregular and unpredictable demand; provide satisfaction only in cases of illness which are associated with impairment of physical capacity or even death. (Arrow 1963). In view of these characteristics, influence becomes a crucial factor which impacts the outcomes of the delivery mechanisms.

THE INDIAN PUBLIC HEALTH SERVICE DELIVERY SYSTEM: The Indian health care system in the public sector is designed to implement disease specific programmes through a widespread and elaborate network of health care professionals. At the district; which is the basic unit of administration in the country; the health care service delivery set up consists of a networked set of facilities. Starting with the sub centers (one sub centre for every 5000 population), the network hierarchically builds up to the level of the district hospital. The primary health centre (PHC) is the first line of referral cum service delivery centre where a qualified physician is posted as in charge of all activities being undertaken by them. The PHC controls a network of sub centers manned by supervisory and front line paramedical staff. The service delivery is done both through the front line paramedical staff and the medical officer of the PHC (NCMH 2005). The medical officer, by virtue of being the first line of qualified personnel for referral services and as in charge of the service delivery organisation, has the dual job of influencing the performance of the staff under him and the customers with whom he directly deals with as referrals. Thus influence is directed towards both the service deliverer and the recipient. One of the important programmes run by the government of India is the Reproductive and the child health (RCH) programme which has been recently revamped. The RCH aims to improve the health of the mother, child and the adolescent female. THE REPRODUCTIVE AND THE CHILD HEALTH PROGRAMME: It consists of four sub programmes. They are: 1. Population stabilization through family planning activities 2. Improve health of the mother through maternal care program 3. Improve the health of the child through child health program 4. Improve female adolescent health India accounts for 25% of the global maternal mortality and infant mortality rate. The infant mortality rate (no of deaths of infants/1000 live births) has stagnated at 65 for the last 10 years after it witnessed a sharp drop from 91 in 1990 to 65 in 1996. The maternal mortality rate (no of maternal deaths per 100000 pregnancies) has been stagnating around 540 for the last ten years. The major reasons for the stagnation in these two critical indices have been poor access to antenatal, delivery and post partum care. A very low percentage of deliveries were conducted by trained health personnel and a resultant high rate of infant deaths in the first 28 days of child


birth. The quality of antenatal delivery, and post partum care have a significant impact on neo natal death rates which are contributing maximum to the infant mortality rate. In view of these factors, the emphasis in the RCH program has been shifted from population stabilization to providing access to mothers and neonates to institutional facilities for deliveries and associated care including emergencies and complications. Two specific programmes have been started in the state of Gujarat namely the Chiranjeevi and the janani suraksha yojana (JSY). Both the programmes are aimed at the population which is below the poverty line (below BPL families). The aim is to facilitate access to those poor families who are not in a position to afford access to institutional facilities for obstetric and gynecological care (Bhat et al 2006). The aim of this paper is to look at the role of the medical officer at the PHC in the implementation of the RCH program and test the central proposition that differences in performance of middle level managers is contingent upon their effective use of influence to maintain staff commitment. METHODOLOGY: The choice of the context for the hypothesis testing is based on the fact that influence plays a significant part in achievement of the performance targets in the health care service delivery and that differences in performances are largely dependent on the effective use of influence by the medical officers. The medical officer in this case can be considered as the middle level manager as he is at least three levels away from the top management and is two levels above the front line staff that render majority of the services (Floyd and Woolridge 1992). Although he is involved in direct delivery of referral service; this can be viewed as a necessity for him to establish his technical competence which is crucial for him to establish trust among his staff and customers. This is an antecedent which influences his ability to effectively use influence tactics to foster commitment among his frontline staff. Sample and design: The study consisted of comparing the performance of two medical officers of two PHCs. The performance with respect to the Reproductive and child health program and the two schemes under it was chosen. At the PHC level this is the flagship program under implementation and caters to a significant section of the population. Considering the importance of the programme in the overall scheme of health services; it is presumed that significant portion of the effort and


resources go into the implementation of the programme and achievement of the targets under this programme would be of importance to the medical officer of the PHCs. Literature states that effectiveness of influence depends upon individual and contextual factors. Since the aim is to study the effectiveness of use of influence; control of contextual factors is established by the choice of the PHCs. The district Sabarkantha was chosen for convenience and for the fact that this was one of the districts where the Chiranjeevi scheme was implemented. To control for contextual factors; the block Prantij and the PHCs poglu and moyad were chosen. Both the taluks covered by the PHCs have more or less same socio economic indicators as indicated by the district officials. Both the taluks have roughly 7% of the population below poverty line; same population levels (approximately 51000); equal ease of access by road to district head quarters and the national highway to Udaipur. Both the PHCs have been rated as A in the ratings for 2005-06(see transcript of interview with District officer RCH). Both the PHCs had had the same MO for more than one year. Effectiveness of influence tactics has been studied using the critical incidents method (Fable and yukl 1992). Commitment on behalf of the user of influence tactics leads to persistence and greater chances of success (Kikul and Neuman 2000). Commitment has also been studied using the survey instrument in form of questionnaires (Meyer and Allen 1997). Effectiveness of use of influence leading to commitment in the lower staff is built over time. The medical officer needs to maintain his influence over time to enable achievement of targets by the lower staff. There fore resorting to cross sectional study would not have established this fact. Hence it was necessary to study the process over time. In view of paucity of time and resources, it was decided to go for retrospective histories; which is considered appropriate for processual studies (Pettigrew 1997). The aim is to identify some critical incidents and look at the behavioral response of the two medical officers which would give an indication of their commitment. This is appropriate since affective commitment has been defined as strong emotional attachment and involvement with the organisation which is reflected behaviorally as initiative and persistence (Meyer and Allen 1997). Semi structured interviews were used. Interviews were conducted with the Additional director/ medical services; the district officer (RCH) of Sabarkantha; Block health officer (BDHO); the medical officers of the PHCs Poglu and Moyad.


Variables: The dependent variable is the performance achieved against targets under the various sub programmes of the Reproductive and the child health programme (RCH). The performance for the current period was considered as appropriate as the effort put in is with respect to the targets of the current period and there fore current performance reflects the outcomes of the effort being put in. Data on performance against targets given in the programme were collected from the Block health officers office at Prantij. The Block health officer is the immediate supervisor of the PHCs in the block and is directly concerned with their performance. The independent variable is identified as affective commitment on behalf of the medical officer/PHC. Affective Commitment has been defined as employees identification, or strong emotional attachment and involvement in the organisation (Meyer and Allen 1997). It is reflected in the behavior as initiative and persistence (Kikul and Neuman 2000). While initiative represents a work behavior defined as self starting and proactive that overcomes the barriers to achieve a goal (Frese et al 2001); persistence is to see that setbacks occurring as part of change or inertia from implementers is overcome. Persistence is a dimension of initiative (Frese et al 2001). FINDINGS AND DISCUSSION: The comparative figures for performance against the sub programmes under the RCH and the schemes of Chiranjeevi and JSY are placed as annexure A. Also indicated in the same annexure is the staffing status of the PHCs under study. The figures are for the period April to October of the current financial year although the work load is for the entire financial year. From the tables the following findings stand out: 1. Both the PHCs have equivalent levels of work load as targets under various sub programmes even though both cater to the same level of population. In the case of Moyad, the smaller number of staff is compensated by the reduced work load in line with number of sub centers under its control. 2. The performance of PHC Poglu is superior to that of PHC Moyad in all the sub programmes and the two schemes. In the maternal health sub programme, Poglu PHC has a higher percentage of deliveries in its own sub centers; in government institutions including its own referral units. Its institutional deliveries are lesser as compared to Moyad PHC.


3. In the family planning activities, Poglu has performed better than Moyad in distribution of oral pills and condoms while both are equal in the category of sterilization operations and insertion of IUDS. 4. In the immunization programme the significant finding is that Poglu PHC has not only done better in all types of vaccination but significantly it has achieved far higher figures in immunization of the girl child. 5. In the implementation of Chiranjeevi and JSY, Poglu PHC has done better in coverage, (achieved 92.3 %), done more numbers in both schemes. The significant finding is the still large numbers of deliveries conducted under the JSY scheme. From the interviews of the Additional director and the Block health officer, it is apparent that commitment on behalf of the Medical officer is the key factor which significantly influences the commitment of staff and subsequent performance. Three incidents highlight the difference in the commitment of the Medical officers. 1. First is the utilization and implementation of the facilitating factor of untied funds for contingencies both at PHC level and sub center level. 2. Second is the non availability of the self generated targets as part of the action plan creation process and its comparison with the actual targets. 3. Third is the significant difference in the focus on special groups; greater number of deliveries conducted in their own sub centers and at their own referral centers. Associated with it is the focus of the identification of the below poverty line families and generating institutional access to them Utilization of untied funds: . A scheme of untied funds has been started under the RCH and the NHRM. Under NRHM, contingency funds up to 10000 rs for sub centers; 25000 rs at PHC level and 50000rs AT CHC level have been sanctioned and disbursed for use for tackling contingencies. The state has been asking the medical officers of PHCs to take advantage of the contingency funds being made available to them at sub center and PHC level. Problems are encountered in motivating Medical officers to promote the use of these funds both at PHC and sub center levels B.K. Patel additional director/ medical services The problem of petty repairs to sub centre and supply of consumables is now easily addressed. Recently we have been given untied funds for use in contingencies under the NRHM; which I


have distributed to the sub centers. Those funds help in sorting out most of these problems. Dr D.K. Mehta / Medical officer / Poglu No; we do not have any contingency funds Dr. Rajesh Patel/ medical officer/ Moyad The first instance indicates the differences in the personal initiative on behalf of the two medical officers (Frese et al 1997); the differences in the approach to problem solving and also involvement with the organisation. At the information level it shows the greater awareness of the organisational context by the Medical officer Poglu and his ability to see an opportunity to facilitate organisational task execution. It also corroborates the problem of motivation to use these funds. Non availability of self generated targets: Generally the variation between the filed proposed targets and the communicated targets does not exceed 10%. In our case this year the variation has been larger. A comparison of the figures sent by us in form 1 and those communicated to us reveals this. The targets given by the district authorities are accepted and we try to do our best. I try to convince the staff to accept the revised targets. Dr D.K. Mehta / Medical officer / Poglu In the case of Moyad; the said document could not be produced. The second incident reveals the lack of importance attached to documents indicating decreased attachment to organisation. Greater focus on special groups Poglu has also managed a greater focus on the two special programmes meant for the underprivileged and special focus groups which reflects in the greater coverage of the girl child in the immunization programme and better performance in both JSY and Chiranjeevi schemes. They have also conducted greater number of deliveries in their own sub centers and referral units. This incident clearly highlights the differences in capabilities of the staff; the self confidence to deploy them and the customer trust in the staff. These three incidents clearly highlight the difference in the commitment levels of the Medical officers based on the differences in the innate abilities, greater awareness of organisational context, greater personal initiative and resultant greater customer trust (Floyd and Woolridge 1996, 2000; Frese et al 2001). From the above one can tentatively conclude that the differences in the performance outcomes of the two PHCs was due to the difference in the individual abilities of the medical officers to


effectively use influence as indicated by their commitment to the organisation. The assumption in the case is that the ability of the staff working under the two medical officers is the result in their ability to sustain commitment of the lower staff. This assumption can be safely made as the staff working in both the PHCs would have the same innate ability, based on their screening and selection for these posts. This leads us to the fact that the central proposition expounded that differences in performance of middle level managers is contingent upon their effective use of influence to maintain staff commitment stands supported. CONTRIBUTIONS, LIMITATIONS AND DIRECTIONS FOR FUTURE RESEARCH The study attempted was an exploratory one and was restricted to a single instance or case study using retrospective histories. There is a need to extend the study to a larger sample of case studies and to different contexts. However, the study opens up new avenues for future research. The role of the middle manager needs to be looked at from the perspective of development and deployment of capabilities which play a significant role in the success of influence tactics and thereby the commitment of the lower staff. CONCLUSION This paper attempted an exploratory study to link the effectiveness of use of influence tactics by middle level managers and its impact on unit performance. The proposition stands tentatively supported which opens up new research opportunities in the study of the role of middle level managers. It is argued that further research in this stream would facilitate the linkage between strategic renewal and organisational adaptation.


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Mathieu( 1994); Antecedents to

organisational issue interpretation: The roles of single level, cross level and content cues; The


ANNEXURE A: PERFORMANCE INDICES FOR PHCS POGLU, MOYAD AND CHAMARA. TABLE 1: Comparison of indicators of maternal health (Prantij block; Sabarkantha district) Indicators Maternal health POGLU MOYAD MAJARA Ante natal registration( load) 1552 854 1549 Registered 861 418 763 % early registration 66.32 69.38 56.36 3 medical check up 935 326 555 Institutional deliveries(load) 1410 777 1409 Sub centre 102 46 3 Own referral units 27 34 1 Other government hospitals 166 18 107 Private hospitals 417 431 462 Domiciliary deliveries(total) 163 33 40 Doctors 17 0 18 Nurse/ANM 98 30 17 Trained attendant 48 3 3 Untrained 0 0 2 Total deliveries 875 595 653 % Delivery in government institutions 33.7 16.4 17 % Delivery at home 18.6 4.2 16.38 % Attended by skilled person 100 100 99.6 % Delivered in institutions 62 76.6 46.3 TABLE 2: Comparison of indicators of family planning activities (prantij block; sabarkantha district) Indicators Family planning activities Actuals achieved/targets Poglu Moyad Majara Operations 154/ 495(31.1%) 85/272(31.1%) 117 IUD 538/889(42.7%) 219/498(43%) 378 Oral pills 209/222(94.1%) 105/125(84%) 206 Emergency contraceptives 0 0 0 Condoms 778/1237(62.9%) 400/680(58.8%) 791


TABLE 3: Comparison of immunization activities (prantij block; sabarkantha district) Indicators Immunization activities Actuals achieved Poglu Moyad Majara Work load 1322 728 1321 Male childrenBCG 425 245 363 DPT 408 248 372 Polio 442 219 372 Measles 538 247 379 Fully immunized 439 219 379 Female childrenBCG 406 193 306 DPT 394 206 301 Polio 405 198 301 Measles 356 202 282 Fully immunized 402 171 279 Total childrenBCG 831(62.8%) 438(60.1%) 669 DPT 802 454 673 Polio 847 417 673 Measles 894 449 661 Fully immunized 841(63.6%) 390(53.57) 658

TABLE 4: Comparison of deliveries under Chiranjeevi and JSY (prantij block; sabarkantha district) all figure for year 2006-07(except as indicated) Indicators Poglu Moyad Majara Population 52298 51629 50442 No of BPL families 732 718 1108 Percentage of population of BPL 7% 7.1% 11% Birth rate( 2005) 22.36 % 21.79% 22.67% Deliveries under Chiranjeevi (up to oct.) 58 49 64 Beneficiaries/Deliveries under JSY 64/27 27/7 33/7 Work load (for 6 months) 92 90 139 % BPL families covered 92.3 62.2 51


TABLE 5: Salient socio-economic and health situation features of sabarkantha district (2004) Indicator Value Population in thousand 2189 Density per square kilometer 282 Sex ratio 797 Literacy rate 67.32 % Urban population 10.89 % BPL population 54 Road length per square kilometer 60 Total fertility rate 2.25 Girls married below age 18(as %) 29.7 % Delivery in government institutions 8.6 % Delivery at home 36.9 % Attended by skilled person 72.3 % Delivered in institutions 62% % Total workers 45.15 % full ANC ( 3 medical check up) 23 % institutional deliveries( 2006 up to November)/state 73/(60) IMR(2006)/ state IMR 52/(62) MMR( 2006)/state MMR 162/( 389) TABLE 6: Indicators of performance for family planning and immunization activities Indicators Poglu Moyad Self Final Self Final generated targets generated targets sterilization operations 488 495 269 272 IUD 936 889 na 495 condoms 1309 1237 na 680 oral contraceptives 259 227 na 125 ANC 1473 1551 na 855 deliveries 1288 1322 na 777 BCG;VIT A; DT 1272 1322 na 728 TT Ist dose 1465 1257 na 855 rd TT 3 dose 589 562 na na TABLE 7: STAFFING STATUS: Poglu: PHC MO+ pharmacist+ lab technician+ staff nurse+ 10FHW+ 5 MHW+ 2 supervisors +driver2 vacancies; 12 sub centers Moyad : PHC MO+ pharmacist+ lab technician+ staff nurse+ 5FHW+ 2MHW+ 3 supervisors+ driver2 vacancies; 7 sub centers Majara : PHC MO+ pharmacist+ lab technician+ staff nurse+ 7FHW+ 4MHW+ 2 supervisors +driver2 vacancies; 9 sub centers