Hospital middle managers' perceptions of their work and competence.

Middle managers in acute care hospitals in New England rated the importance of most work roles and skills higher than their competence to perform them. Being male, having a bachelor's or graduate degree, and reporting to a vice president were related to higher competence ratings for some roles and skills while having held a clinical position in the same organization was related to lower ratings. Middle managers rated skills and roles focused on their individual work units as more important than those associated with their organizations or external environments. This framework for categorizing work may be useful in identifying education, institutional support, or work redesign that would assist middle managers in being more effective.