Leading top-down implementation processes: a qualitative study on the role of managers

Håkan Uvhagen,Henna Hasson,Mia Von Knorring,Johan Hansson

doi:10.1186/s12913-018-3360-y

Abstract

BackgroundLeadership has been identified as an influential factor in implementation processes in healthcare organizations. However, the processes through which leaders affect implementation outcomes are largely unknown. The purpose of this study is to analyse how managers interpret and make sense of a large scale top-down implementation initiative and what implications this has for the implementation process. This was studied at the implementation of an academic primary healthcare initiative covering 210 primary healthcare centres in central Sweden. The aim of the initiative was to integrate research and education into regular primary healthcare services.MethodsThe study builds on 16 in-depth individual semi-structured interviews with all managers (n = 8) who had operative responsibility for the implementation. Each manager was interviewed twice during the initial phase of the implementation. Data were analysed using a thematic approach guided by theory on managerial role taking based on the Transforming Experience Framework.ResultsHow the managers interpreted and made sense of the implementation task built on three factors: how they perceived the different parts of the initiative, how they perceived themselves in relation to these parts, and the resources available for the initiative. Based on how they combined these three factors the managers chose to integrate or separate the different parts of the initiative in their management of the implementation process.ConclusionsThis research emphasizes that managers in healthcare seem to have a substantial impact on how and to what extent different tasks are addressed and prioritized in top-down implementation processes. This has policy implications. To achieve intended implementation outcomes, the authors recognize the necessity of an early and on-going dialogue about how the implementation is perceived by the managers responsible for the implementation.

Highlights

Leadership has been identified as an influential factor in implementation processes in healthcare organizations
Factors influencing how the managers interpreted the implementation task the managers were fairly similar regarding their descriptions of the content and the rationale of the initiative, they differed with respect to how they interpreted and made sense of the task
The findings suggest that the managers’ perceptions of the different parts of the implementation initiative, of themselves in relation to these parts, and of the resources that are available for the initiative have an impact on how the task is constructed and thereby on the actions that are taken in the implementation process

Summary

Introduction

Leadership has been identified as an influential factor in implementation processes in healthcare organizations. In a study of leadership in implementation of evidence-based methods in healthcare, Aarons et al [15] suggested a comprehensive model including four aspects that managers need to cover in order to achieve effective implementation processes. They need to be proactive by producing and communicating a plan for the implementation, and Uvhagen et al BMC Health Services Research (2018) 18:562 by finding and addressing circumstances that hinder the implementation process. This function was identified as an important managerial task in a literature review by Gifford et al [17]

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