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

Area of Science:

• Healthcare Management
• Organizational Change
• Primary Healthcare Innovation

Background:

• Leadership is a key factor in healthcare implementation, but the specific mechanisms are unclear.
• This study examines managers' sense-making of a large-scale, top-down initiative to integrate research and education into primary healthcare.
• The initiative spanned 210 primary healthcare centers in central Sweden.

Purpose of the Study:

• To analyze how healthcare managers interpret and make sense of a large-scale, top-down implementation initiative.
• To understand the implications of managers' interpretations on the implementation process.
• To explore the integration of research and education into primary healthcare services.

Main Methods:

• Conducted 16 in-depth, semi-structured interviews with 8 managers responsible for the implementation.
• Interviewed each manager twice during the initial implementation phase.
• Analyzed data thematically, using the Transforming Experience Framework for managerial role-taking theory.

Main Results:

• Managerial sense-making was influenced by perceptions of the initiative's parts, their own role, and available resources.
• Managers integrated or separated initiative components based on these perceptions.
• These interpretations shaped how implementation tasks were managed and prioritized.

Conclusions:

• Healthcare managers have a substantial impact on the prioritization and execution of tasks in top-down implementation.
• Effective implementation requires early and continuous dialogue with managers regarding their perceptions.
• Policy implications highlight the need to involve managers in shaping implementation strategies for better outcomes.