Management by Knowledge in Practice – Implementation of National Healthcare Guidelines in Sweden

In the last ten years, the concept of management by knowledge has gained growing attention in S wedish healthcare, as well as internationally. In S weden, the most prominent example of management by knowledge is the N ational G uidelines, aimed at influencing both clinical and political decision‐making in the health sector. The objective of this article is to explore the response among four S wedish county councils to the N ational G uidelines for Cardiac Care ( NGCC ). Empirical material was collected through 155 expert interviews with the target groups of the NGCC , politicians, administrators and clinical managers. Analysis of the responses to this multifaceted policy instrument was addressed by drawing on implementation theory (Matland 1995) and institutional theory (Oliver 1991). The NGCC are primarily based on the voluntary diffusion of norms. The county councils are a long way from having adapted all the means suggested by the N ational Board of Health and Welfare ( NBHW ): explicit prioritization, healthcare programmes and dialogue between the various actor groups. The high degree of ambiguity in the content of the NGCC , the inherent conflict and the multiplicity and uncertainty in the context of the county councils, have often resulted in avoidance and compromise. The strategic responses we observe can be viewed as an attempt to balance multiple constituents and achieve the various internal organizational goals. The ambiguity and conflict inherent in the policy of the NGCC influence the strategic responses made by the organization. The question remains how far management by knowledge can be applied in a political context.