A view from the top : the local politico-administrative leadership in implementing evidence-based practice in social services

Abstract: Background: Evidence-based practice is a way to integrate three knowledge sources into decision-making: research evidence, professional expertise, and client preferences and experience. It is argued that evidence-based practice may enhance client rights, strengthen the professional’s role, and make relevant use of scarce resources. Evidence-based practice has been an articulated objective in social services for several years. In Sweden this has been brought about through a policy agreement between the Swedish Association of Local Authorities and Regions and the government, and through national knowledge management that concerns the development, spread, and use of the best knowledge available. Despite great national efforts, its implementation in social services has met difficulties. It has been contended that it is challenging for professionals to use evidence-based practice individually, and many of the barriers identified are related to leadership and the organizational context. That makes highly relevant the views and actions of the politico-administrative leadership, i.e., management and local political committees responsible for social services. Aim: The overall aim of this thesis is to contribute knowledge about the implementation of evidence-based practice in social services through the lens of the local politico-administrative leadership. More specifically, this thesis explores contextual factors influencing the implementation of evidence-based practice (Study I); the roles, actions, and prerequisites of local political committees in implementing evidence-based practice (Studies II–III); and whether an intervention targeting local political committees is feasible and may assist the committees in supporting the implementation of evidence-based practice (Study IV). Methods: A mixed methods approach is used. Study I and II are qualitative interview studies employing semi-structured interviews with top- and middle-level managers in social services and local politicians; chairs and vice-chairs of social welfare committees. The findings from Studies I and II were used to inform Study III, which is a cross-sectional survey study aimed at chairs and vice chairs of local political committees responsible for social services. The results from Studies I–II were then used, together with workshops and interviews with local politicians and representatives from social services, to develop and assess an intervention to aid political committees in supporting the implementation of evidence-based practice. Interviews and surveys were used in Study IV to assess the feasibility, acceptability, appropriateness, and learning outcomes of the intervention. Findings: In Study I, top-level managers put greater emphasis on strategic concerns and support systems for implementation, whilst middle-level managers were concerned with operational issues on the staff level. Furthermore, most top-level managers viewed evidence- based practice as the integration of the three knowledge sources, while the interpretations of evidence-based practice among middle-level managers varied. Lack of support for evidence- based practice on various leadership levels, in combination with different understandings of what it entails, might jeopardize the alignment of support for evidence-based practice in some social service organizations. Study II found that local politicians were somewhat unfamiliar with evidence-based practice and policy. Lack of knowledge, hesitancy towards inquiring about specific working methods, and the need for support seemed to impede actions to foster implementation. Personal interest seemed to be of importance in determining the politicians’ roles, with some being more active and others being uninvolved. The managers wanted the politicians to endorse implementation by setting a budget and objectives that assist evidence-based practice and following up on the results in social services However, the awareness among the politicians that these actions had influence on the implementation of evidence-based practice was limited. In Study III, the local political committees’ actions could be categorized in three groups— passive, neutral, and active—based on the committee chairs and vice chairs’ reports about the actions taken to support the implementation of evidence-based practice. Moreover, a positive relationship between reported actions and perceived prerequisites was found. The perceived capability, motivation, and opportunity for the committees to act were highest in the active group and lowest in the passive group. Study IV found that an intervention to enable local political committees to support evidence- based practice in social services was satisfactorily acceptable and appropriate. The intervention was perceived as interesting and created curiosity and knowledge about evidence-based practice. However, some alterations are needed to increase the intervention’s feasibility, such as the careful anchoring of the intervention before start and local adaptations regarding the delivery format. Further, skills training could be added to the intervention. The collaboration between the political committee and the social services department is vital and should not be excluded from the intervention. Conclusions: Factors impeding the implementation of evidence-based practice in social services were found related to capability, motivation, and opportunity in the organizations. This implies that support efforts need to be multifaceted and not focus only on single aspects, such as increasing knowledge. The local politico-administrative leadership seem mutually dependent on each other in supporting the implementation of evidence-based practice. Many managers wished the local political committees would more clearly support implementation by indicating in various ways that evidence-based practice is a priority. The politicians were, in turn, reliant on the social services administration for receiving information. However, the knowledge among politicians was limited, the understanding of what evidence-based practice entails differed among the managers, and there were divergent views on what role the political committees should have. Awareness about and reflection on these different understandings and expectations should therefore be cultivated in an effort to align support for evidence-based practice in social service organizations. Some local political committees were more active than others, implying that the local politico-administrative leadership have the potential to act as a unifying force in implementing evidence-based practice. An intervention targeting increased capability, motivation, and opportunity might be one way forward to aid local political committees in supporting evidence-based practice. The intervention was positively perceived, but further evaluation is needed.