Contributions to the literature
-
Research shows that supervisors and other middle managers play an important role in implementation by shaping the implementation climate (i.e., shared belief that implementation is expected, supported, and rewarded).
-
We found that supervisors fulfilled four roles during implementation: they diffused and synthesized information, mediated between strategy and day-to-day tasks, and justified implementation. Together, these roles interacted to convey expectations and support for implementation at the front lines.
-
We did not find a robust evidence of how supervisors convey rewards for implementation.
-
These findings fill the gaps in knowledge about the specific ways in which supervisors influence implementation.
Background
Implementation climate
Supervisors’ roles in implementation
Methods
Study context
Participants
July 2015 (6 groups), total | July 2016 (6 groups), total | Participated 2016 only, total | Participated both years, total | Unique participants, total | |
---|---|---|---|---|---|
Behavioral health clinicians | 7 | 4 | 4 | 0 | 11 |
Intake workers (2 groups) | 14 | 15 | 11 | 4 | 25 |
Ongoing workers (2 groups) | 18 | 13 | 11 | 2 | 29 |
Supervisors | 12 | 8 | 6 | 2 | 18 |
Total | 51 | 40 | 32 | 8 | 83 |
Data collection procedures
Analysis
Results
What do supervisors do during implementation?
Supporting quotes | Notes |
---|---|
Diffusing information | |
Interviewee 1: So maybe our training just … didn’t go over the parts we need every day… like how to implement it and the daily processes maybe. Interviewee 2: Or we got the training, and you didn’t have one for months. Interviewee 1: So then you ask your supervisor, and so whatever they heard is what you do. (Intake, July 2016) | Example of diffusing information by relaying information to frontline clinicians |
I asked a supervisor today-I said, Oh, are you coming to the Gateway CALL focus group today?” And s/he said, “What’s Gateway?” (Ongoing, July 2015) | Example of lack of diffusion of information about an innovation |
Synthesize information | |
But you also have to make sure that the worker understands what they’re reading because we have different levels of ability and skill levels within the unit. I mean, I’ve got one [worker] who’s been there for almost eight years, and I’ve got one who’s been there four weeks. …if that four weeker was to get one of these [cases], it’s like, okay we’re gonna have to sit down and we’re gonna have to explain the whole thing. So skill level of the worker and their experience goes into it. (Supervisors, July 2015) | Example of synthesizing information by tailoring information to individual worker |
I’ve had a case where [in-person] wasn’t an option. So [my supervisor] was like, “Well, if you could catch her on the phone, if you could get those questions and do it that way.” (Intake, July 2016) | Demonstration of troubleshooting challenging cases and adapting to the local context |
Mediating between strategy and day-to-day tasks | |
I guess, if things are really followed-up on, like how they’re supposed to be, so my supervisor’s aware that I [have a Gateway CALL case]. She asks, “Do you have it [the assessment] back? What are the recommendations?” Cuz’ then she puts in her notes. “Okay, what’s the next step? Who’s making the referral, you or CALL?” “CALL.” Okay, next month, “Is your kiddo linked with X, Y, and Z?” (Ongoing, July, 2015) | Example of mediating by identifying specific activities for implementation |
And I, as a supervisor, it’s hard to keep on top of them to make sure they have some of the key points that were mentioned in the Gateway CALL [assessment], so it just depends on that, and sometimes that takes even more time, because I have to decline the case plan because it didn’t include that information. (Supervisors, 2015) | Illustration of mediating by monitoring implementation and providing feedback |
Even when we have trouble scheduling. Which I did, several times. Or connecting with a caseworker. He was very, hands on in contacting them and just putting that little extra push, getting them to call me (Behavioral Health, July 2015) | Example of mediating via engaging in implementation activities |
Selling implementation | |
I think that the support is up high, but it’s not trickling down, …If it’s that important to them, then educate your workers, your employees on the importance of this program. So that that support trickles down. We have supervisors tell us, “What is this? We don’t know what this is, or why we’re doing it.” (Behavioral Health, July 2016) | Example of implementation is not well sold within the organization |
Diffuse information
Synthesize information
Mediating between strategy and day-to-day tasks
Selling implementation
How do supervisors influence implementation climate?
Convey expectations
Interviewee 1: I mean, my supervisor made it kind of mandatory, so it’s like, “You forgot it the one visit. Like, well, guess you got to go back out.” But that’s about it.
Interviewee 2: Our supervisor wrote up on a white board in her office if we had a custody case, and she wrote, “Gave to CALL.” So, we’d kind of check on each other but also see for ourselves.
Interviewee 3: It’s on the face sheet too. They would write, “You need to complete Gateway CALL.” (Intake, July 2015)
Provide support
So [my supervisor], was really involved in that one, really helped with the interpretation and we had a meeting after that and another call when it come through just to kind of review where we were at. And, so there was a lot of support in that first part. (Behavioral Health, July 2015)
Reward implementation
There is not a lot of thanks in our job. People don’t want to see us. People do not like us. You know? … So, when your supervisor does say, like, good job, it’s just like … I did do something right today even though I have 35 voicemails from people screaming at me. You know? … Just having that sometimes is enough to be like, oh, okay. Well, all hope isn’t lost… (Intake, July 2015)