The View from Above: The Relationship Between Senior Management Perspectives and Front-Line Implementation

Title:   The view from above:  The relationship between senior management perspectives and front-line implementation  

Background and Purpose

The literature on implementation science implies a positive relationship between senior management perspectives (SMP) and implementation outcomes; namely, that implementation outcomes will be better if SMP are positive as they relate to the change effort at hand.  However, there is little in the way of concrete evidence to support this suggestion.  

This study explores the relationship between SMP on a particular change effort (the implementation of a brief assessment tool used in the context of child protective services) and actual implementation of the assessment tool. We hypothesized that implementation levels would be higher in regions where SMP was positive as they relate to the implementation effort. 

Methods

Data and sample:  This mixed method study paired qualitative data (in-depth, one-on-one interviews) with administrative data from four geographic regions within one large, Southern state.  Senior administrators from the four regions were interviewed (n=18) about their perspectives on the implementation of an adapted version of a validated assessment tool.  Interview data was coded using an index that classified SMP as positive, neutral, or negative.  

Implementation levels were derived using two main data sources.  First, children eligible to be assessed via the new assessment tool (n=44,402) were identified using data from the state’s administrative database.  Second, children actually assessed using the new tool (n=28,902) were identified using a separate database.  Linking the state administrative database and the stand-alone assessment database made clear the extent to which eligible children were assessed using the new tool, according to state policy. 

Statistical approach:  Logistic regression was used to determine the relative likelihood of a child being assessed as intended, given senior management perspectives.

Results

By and large we saw a fair amount of consistency within each region as to senior management perspectives on the implementation of the new assessment tool.  Of the four regions under study, one was characterized as having positive SMP, one as having negative SMP, and two as having average SMP.

The odds of front-line staff using the new assessment tool was significantly higher in the region characterized by positive SMP than in the region with negative SMP (OR=1.115, p<.0001).  Front-line staff from the region with positive SMP were more likely to use the assessment tool than front-line staff from one of the two regions with average SMP (OR=1.029, p<.0001).  Staff from the second region with average SMP were actually more likely than the staff from the region with positive SMP to use the assessment tool (OR=3.287, p<.0001). 

Conclusions and Implications

The results of this study suggest that senior management perspectives play a role in the front-line implementation of new practices and procedures. Given that senior management perspectives have not traditionally been considered a lever in the implementation process, this study may open new directions for inquiry in the field of implementation science.