Article

Public Policy and Administration

2018, Vol. 33(1) 66–87
Meet the local policy ! The Author(s) 2016
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DOI: 10.1177/0952076716683568

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guidelines in Denmark
Camilla L Wimmelmann,
Signild Vallgårda and Anja MB Jensen
Section of Health Services Research, University of Copenhagen,
Denmark

Abstract
Reporting on an interview and observation-based study in Danish municipalities, this
article deals with local policy workers and takes it’s departure in the great variation we
observed in implementation of centrally issued health promotion guidelines. We pre-
sent five types of local policy workers, each of whom we found typified a specific way of
reasoning and implementing the guidelines. This typology illustrates the diversity found
within a group of local policy workers and helps explain the variability reported in most
studies on policy/guideline implementation. On the level of individuals, variation in
implementation is often explained by the implementers’ perceptions of need for, and
potential benefits of the policy, self-efficacy and skill proficiency. We add ‘professionally
related experiences’ as another explanation. We introduce the concepts of translation
and hinterland to understand how and why people in the same positions receiving the
same set of guidelines implement them differently and suggest that local policy workers’
professionally related experiences affect the frames in which they translate the guide-
lines and decide upon the strategies of implementation. As such, this article illustrates a
residual order of implementation practice: the unruly and elusive part of public policy
implementation, ordered only partly by the centrally issued policies.

Keywords
Guidelines, health promotion, implementation, local policy workers, public
administration

Corresponding author:
Camilla L Wimmelmann, Section of Health Services Research, University of Copenhagen, Øster
Farigmagsgade 5B, Building 10, 1014 Copenhagen K, Denmark.
Email: cwi@sund.ku.dk
Wimmelmann et al. 67

Introduction
This article deals with the local implementation of centrally issued public policies
by taking the national Danish health promotion guidelines as a case. In so doing, it
focuses on the people who are presupposed to implement the guidelines locally –
namely, the local policy workers, defined as the people working with the local
government’s strategy, implementing and assigning the local priorities and mana-
ging as well as shaping the local services. In this article, we put a face on the local
policy workers and illustrate how the implementation of public health guidelines is
shaped by the policy workers’ professionally related experiences.
In public policy, and especially within the field of public health, guidelines are
abundantly issued by central governments to streamline or standardise the local
authorities’ practices (Rod and Høybye, 2015) according to an often evidence-
based routine or sound practice. Thus, we regard guidelines as a policy in the
following. Inherent in the use of guidelines as a form of regulation (Timmermans
and Epstein, 2010) is the premise of a linear knowledge-to-action process (Hjelmar
and Møller, 2015). This premise is a matter of a rather straightforward and top-
down mechanistic and apolitical process of implementation in which the local
policy workers are expected to carry out the guidelines as formulated and endorsed
by those in authority such as politicians – reflecting the belief that local policy
workers are neutral conduits through which guidelines flow intact and unmediated
(Kingfisher, 2013). As such, regulation by the use of guidelines adheres to a
‘technocratic idea of rational policy’ (Jenkins, 2007), even though scholars decades
ago showed that such rational models of policy-making were ‘not effective in prac-
tice, nor convincing in theory’ (Parsons, 1995: 468). Yet the premise of regulation
by the use of guidelines greatly resembles the belief in ‘rational policy’ processes
and practices (Cairney, 2009; Hjelmar and Møller, 2015; Jenkins, 2007; Markussen
and Wackers, 2015).
Inspired by the seminal work of Michael Lipsky (1980), a range of scholars have
shown that the actions of the local policy workers very often diverge from the
stated policies (May and Winter, 2009). Lipsky (1980) illustrated how so-called
‘street-level-bureaucrats’ adapted the objectives of social policies to suit their cli-
ents’ or their own preferences, and concluded that policy implementation, in the
end, comes down to the people who actually implement it. This strand of academic
work is grounded in a constructionist view of social reality, presenting public policy
as a (discursive) construct that turns on multiple interpretations (Fischer, 2003),
and shows how ideals of basic societal goals, pursued by policy-making, often
conflict in policy implementation (Stone, 2002).
Though Lipsky’s work concerned the discretion used by those directly engaged
in policy delivery on the frontline, other studies (e.g. Brewer, 2005; Freeman, 2006;
Kingfisher, 2013) have likewise shown that local policy workers influence the poli-
cies; they interpret and reformulate the policies when they put them into practice.
Actually, as Kingfisher (2013: 62, emphasis in original) claims, ‘in the business of
taking up and doing social policy, those [local policy workers] are key: they are the
means by which policy practices and the ideas informing them are materialised and
68 Public Policy and Administration 33(1)

sustained’. As a result, centrally issued public (health) policies and guidelines are
not merely implemented but rather made through the everyday practices of the
local policy workers (Freeman, 2006; Freeman and Maybin, 2011; Jenkins, 2007;
Kingfisher, 2013). In other words, the local policy workers are very influential in
regard to the actual realisation of centrally issued public health guidelines and thus
in terms of the services provided to citizens.
The empirical findings of these studies stress the importance of methodologies
that emphasise studies of local policy workers’ roles. Such approaches with an
explicit interest in what happens ‘on the ground’ have greater explanatory potential
(Hupe, 2014; Hupe and Hill, 2016). Our ‘advanced implementation study’ (Hupe,
2014) treats the intentions of the guideline (makers) as only one among a range of
variables explaining the implementation variation. In so doing, we emphasise that
local policy workers are not merely ‘local policy workers’; they are people – they are
human individuals whose actions are, like everyone else’s, guided by unarticulated
and embodied understandings rather than expressed rules and prerogatives
(Freeman and Sturdy, 2014; Kingfisher, 2013; Taylor, 1995). Yet the local policy
workers, as implementers of public health guidelines, have been handled as
a homogeneous group of people (such as ‘the civil service’, ‘street-level bureau-
crats’, etc.) in most studies, implying that the knowledge we have of those people is
limited – in fact, we know ‘surprisingly little’ (Freeman et al., 2011: 128; Wagenaar,
2004: 643).
The aim of this paper originates from an empirically based curiosity. While
studying how the Danish national set of centrally issued health promotion guide-
lines was enacted locally in the Danish municipalities, the variation we saw in how
the guidelines were implemented could not be (fully) explained by ‘traditionally’
suggested modifying implementation factors, such as organisational structure, per-
ceived need and agency or financial resources (Durlak and DuPre, 2008;
McConnell, 2015). Focusing on the level of individuals, variation in implementa-
tion has primarily been explained by the implementers’ perceptions of need for and
potential benefits of the policy (Winter, 2003); self-efficacy and skill proficiency
(Durlak and DuPre, 2008); self-interest (Maynard-Moody and Musheno, 2000)
and ‘policy accumulation’: that public professionals often are confronted with
(a series of) policy changes, intended to refine, replace or complement other policies
which results in professionals having a certain predisposition towards policies in
general (van Engen et al., 2016). However, in general, and as Steijn et al. (2012: 4)
argue, at the level of individuals ‘public administration has historically looked
primarily at the content of public policies and discretion issues for explaining the
implementers’ willingness to implement public policies, [but] it seems that this does
not provide the full picture.’
The closer we looked at the moments in which decisions pertaining to the guide-
lines were made, the more the guidelines dissolved into a multiplicity of logics and
strivings for different goals. In some of those moments, the guidelines related to the
centrally issued guidelines in nothing but name. In analysing the variation in the
implementation of the guidelines, we noticed the significance of the policy workers’
Wimmelmann et al. 69

professionally related experiences for how they put the guidelines into practice. The
term ‘professionally related experiences’ should not be confused with professional
‘skills’ or ‘capabilities’ as are handled in literature on ‘professions’ and ‘profession-
alism’. Rather, we have constructed this term to grasp the concrete experiences/
situations that the local policy workers have encountered in their professional lives
and which have formed the local policy workers’ attitudes and meaning-making of
the guidelines. Designating the local policy workers’ experiences in their profes-
sional life, we found that in order to understand the local implementation we
needed to know more about the acting persons and thus place them in the fore-
ground of our study.
Based on interviews and observations in Danish municipalities, we therefore
explore the local policy workers as individuals, what is meaningful for them and
how they perceive and perform their work. This article then adds to the existing
literature in which the black box of ‘local policy workers’ is unpacked (Marston
et al., 2005; May and Winter, 2009) and shows how the implementation of the
guidelines is variously influenced by the individual local policy workers and their
professionally related experiences. As such, it offers a detailed supplement to pre-
vious studies on individual factors that affect the implementation process (e.g. Barr
et al., 2002; Cooke, 2000; Kallestad and Olweus, 2003; Ringwalt et al., 2003) as well
as to studies on (Danish) local policy workers, which have been primarily quanti-
tative and focused on the local policy workers’ demographics (Bo Smith-udvalget,
2015; Hansen et al., 2013) and values (Steijn et al., 2012; Tummers, 2012;
Vrangbæk, 2009). Other Danish studies on local policy workers have focused on
how professional, organisational and governance contexts affect frontline practice
(e.g. Caswell and Larsen, 2015), the political and managerial influences on local
policy workers’ policy emphases (e.g. May and Winter, 2007) and the forms and
modes of authority deployed by case managers when implementing activation
policies (e.g. Marston et al., 2005).
By putting a face on the local policy workers, we narratively illustrate a com-
plexity that helps shed light on the variation often seen in guideline implementa-
tion. Thereby, we leave the acts of the production and formulation of the guidelines
aside and illustrate the residual order of the implementation practice: the unruly
and elusive part of guideline implementation in which things really happen,
ordered, but only partly, by centrally issued guidelines (Freeman et al., 2011).
Accordingly, we present five types of local policy workers we have constructed
from an amalgam of traits from the 15 individuals encountered in our study.
This is not to suggest a certain pattern or to conclude that one or any of these
types are to be found in every local government, or that these are the only five types
existing. Rather, the aim is to illustrate the complexity of individualities that con-
stitute the group of ‘local policy workers’. Thus, readers who engage practically or
theoretically with the implementation of public (health promotion) guidelines are
sensitised to observe and remark – in other cases and other situations – slightly
different but equally relevant phenomena for themselves. The stories we tell here
aim to develop an open eye and inspire keen sensitivity for the complexity we see
70 Public Policy and Administration 33(1)

among the group of local policy workers. In addition to other conditions, such as
political ambitions, the size of the municipalities and economic resources, we argue
that this complexity provides partial explanation and insight into the various ways
in which guidelines are implemented at local levels.

The Danish health promotion guidelines in context

Administratively, the Danish health-care system is fairly decentralised: planning
and regulation take place at both the state and local levels. Following a major
administrative governance reform in 2007, the responsibility for disease prevention
and health promotion was redistributed and is now mainly located at the municipal
level (Olejaz et al., 2012). Thus, the political context in which this case takes place is
a ‘multilevel policy-making system’ as it is characterised by the existence of rela-
tively autonomous layers of decision-making (Torenvlied and Akkerman, 2004).
In 2012 and 2013, the Danish Health and Medicine Authority (DHMA) issued a
set of national health promotion guidelines (consisting of 11 health promotion
‘packages’, comprising a total of 262 recommendations for health promotion ser-
vices) with the aim of supporting the municipalities in their new (post-reform) tasks
and strengthening the quality of the health promotion services across the country
(DHMA, 2013). According to DHMA, the guidelines serve as a means of commu-
nicating ‘how to establish systematic and effective health promotion and disease
prevention actions in a Danish context, [where the notion of] ‘systematic’ implies
that the disease prevention and health promotion work is conducted in order to
reach the same goals and methods across the country’ (DHMA, 2012: 18; our
translation), and thereby signify an attempt at standardisation. Moreover, as
DHMA (2012) suggests that implementing the recommendations from all the
guidelines will help achieve the best and most comprehensive health promotion
practice, it indicates an intention for the municipalities to undertake complete
implementation. To aid the municipalities with this comprehensive implementation
task, the national organisation of municipalities, Local Government Denmark
(LGDK), established the Centre for Health Promotion in Praxis in 2013. The
centre is government funded and the initial support was prolonged for an add-
itional three years. Thus, great efforts have been made to promote the guidelines
and support the municipalities in the guideline implementation process in order to
secure their success (Vallgårda, 2014) – where success is understood in the sense of
DHMA: as complete implementation. Before beginning any implementation, the
municipalities are strongly encouraged by the LGDK to map out their existing
initiatives and rate them according to a ‘traffic light model’, where green signals the
complete implementation of the initiative, yellow signals partial implementation
and red signals no implementation.
The Danish health promotion guidelines are issued in an organisational and
administrative context that more or less corresponds to that of other Western
welfare states, such as the United Kingdom (Gorsky et al., 2014), Norway
(Ringard et al., 2013) and Sweden (Anell et al., 2012). Though the (Danish)
Wimmelmann et al. 71

municipalities are differently organised, they all employ an administration consist-

ing of local policy workers who, amongst other tasks, serve their local politicians
with the basis for decision-making. Inherent in this system is the idea of neutral local
policy workers-which is also the ideal (Vallgårda, 2008). However, recent studies
show that Danish local politicians regard proposals that are not congruent with the
desires and agendas of the municipality’s local policy workers to be difficult – even
impossible – to implement (Bo Smith-udvalget, 2015), signalling a general decrease
in the perceived influence of the local politicians vis-à-vis the local policy workers
(Kjaer et al., 2010). To a great extent, those local policy workers then contribute to
the shaping of public health policies and guidelines through their arrangement and
evaluation of the decisions (Bo Smith-udvalget, 2015; Vallgårda, 2008). Actually, it
has been argued that the local policy workers may be more influential than the local
politicians in terms of the local enactment of centrally issued policies (Jenkins, 2007;
Olsen, 2013; Peters, 2001; Wimmelmann, 2016; Wimmelmann, forthcoming). To
date, no studies have shown how the Danish local policy workers perceive their
level of influence or how their professionally related experiences affect their decision
making in regard to the implementation of centrally issued health promotion guide-
lines. As the local policy workers themselves suggest and are aware that, and how,
their own professionally related experiences influence their decision-making regard-
ing implementation of the health promotion guidelines, this article also indicates
indirectly how they perceive their level of influence.

Methods
Author one investigated how the Danish health promotion guidelines were imple-
mented and enacted by visiting, observing and interviewing 15 local policy workers
from ten Danish municipalities. The local policy workers were employed in
municipalities that differed with regard to geographical area, number of citizens,
socio-demographic profile and health profile. These ten municipalities were selected
to highlight how the guidelines were translated and enacted in different places. For
two years (from April 2014 to April 2016) Author one had on-going contact with
the local policy workers and obtained deep and rich insight into their experiences,
stories and intentions, which serve as the empirical data in this paper. The formal
interviews had a semi-structured approach, and the themes covered concerned the
interviewees’ practical work experience(s) and decisions taken regarding the imple-
mentation of the health promotion guidelines. The interviews varied in duration
from 36 to 96 minutes and were transcribed verbatim. In addition to the interviews,
Author one gained insight into the field through ‘appointed observations’
(Staunæs, 2004) of special occasions, such as meetings or workshops. These obser-
vations enabled us to note some of the circumstances that the local policy workers
did not themselves think of as relevant, were not conscious of or were not willing to
discuss when they were interviewed. Moreover, the observations shed light on
elements of the enactments that might have been tacit, as they were in conflict
with the intentions of the guidelines or with the municipality’s strategic agenda.
72 Public Policy and Administration 33(1)

This study’s data then also represents informal beliefs and practices, as well as
personal narratives. Thus, the insight we obtained through observation, intrigued
us to ask questions of how and why they enacted the guidelines (contrary to the
politically stated intentions), implying that the observations also served to specify
our interview guide continually.
Inspired by hermeneutic methods for analysis (Patterson and Williams, 2002),
the data from the observations and interviews were read and coded in order to
identify and organise relevant and dominant themes (Madden, 2010). At the outset
of the study, the local policy workers’ professional experiences were not a central
concern. However, we quickly realised that the local policy workers themselves
introduced and referred to ‘experiences in their professional life’ and ascribed
such experiences as overtly important, when they explained how they handled
the guidelines. After the field studies, it was clear that these were unavoidable
for understanding the actual implementation practices in Danish municipalities.
Reading carefully through the material, we recognised five ways of reasoning and
handling the guidelines that were all related to a more global theme of ‘experiences
in their professional life’. In the following, we describe each of these five ways by
constructing five types whom we found each represented a specific way of reasoning
and handling the guidelines. The types we present constitute our analytical nomo-
thetic work, as they are condensed from the 15 individuals we encountered in our
study. We present the types using fictitious names followed by a supplementary
explaining title. The reason for naming them is that it helps emphasise the fact that
they are people, not implementation machines. We do however wish to emphasise
that the names are purely fictitious, and that any inevitable assumptions of gender
those names may bring, are not an analytical point. In other words, any belief of a
correlation between each type as relating to a certain gender is not intended, and
our research has been conducted as well as reported appropriately to secure the
confidentiality of our informants.
We do however acknowledge that actions and types are contextualised
(Le Grand, 2003), implying that this study’s contribution is an analytical general-
isation: we believe that such a typological framework illustrates a diversity found
within a group of local policy workers, which helps explain the variety we see in the
implementation of guidelines. This analytical approach also bears the potential to
explain local variations in national implementation processes in other contexts.

Findings
When conducting the interviews and observations, there was not one grand story of
the guideline implementation that emerged. The local policy workers’ different
ways of interpreting and (re)representing the guidelines affected the ways in
which the guidelines were enacted and allowed to act at different sites and in dif-
ferent situations. We now invite our readers to ‘meet’ the local policy workers,
because, as we argue, they are so influential in the actual realisation of centrally
issued public health guidelines, and thus in the services provided to citizens.
Wimmelmann et al. 73

Sarah: The loyal operator

Meet Sarah. Sarah has held her position in the health administration of the muni-
cipality for the last 10 years, and she is both eager and happy to discuss her strategy
for the health promotion guidelines. Initially, she proudly states that she has
decided to implement all the guidelines. However, later on, she explains that she
is not completely satisfied with the health promotion guidelines because, ‘in certain
areas, they lack something; the evidence base of the guidelines is rather flimsy’.
Though Sarah points out inconsistencies in the evidence base that supports the
guidelines, she explains that it did not influence the decision about complete imple-
mentation because, ‘if you only implement and initiate health promotion services
that are evidence based, you will never become better or more skilful’. However,
her motivation for implementing the guidelines completely seems not to be one of
learning and/or innovation; rather, it is very much related to the task of mapping
out the municipality’s existing services according to the traffic light model. She
says, ‘in our area of health promotion, we are ‘‘green’’ all around [. . .] it is not
really satisfying if you see something ‘‘red’’ in there. . . then you feel like ‘‘oh no,
that is not good’’’. In other words, she is motivated by, and focused on, fulfilling
what is expected from her – from one in her position – and in this case, that is the
complete implementation of the guidelines. As such, she is driven by loyalty and
commitment to the mission of fully implementing the health promotion guidelines,
even though she is not completely satisfied with them. By disregarding her own
satisfaction with the health promotion guidelines, she takes the role as an operator
and manages the guidelines according to the belief of an ideal local policy worker
(Vallgårda, 2008). Though Sarah’s driving force and logic are found to be general
core values that local policy workers are expected to hold (Vrangbæk, 2009), in our
study, she represents an exclusive kind of local policy worker. As we will see in the
following presentations, the others are not striving to take on this loyal operator
role. Actually, they believe they do a better job when they are not merely, and
rather unreflectively, implementing the guidelines.

Michael: The moral rebellion

Meet Michael. Every time we meet, Michael passionately shares his concerns and
his motivation and values when he expresses his critical view on the quality of the
evidence base in the guidelines. According to Michael, it is his time back at uni-
versity that familiarised him with, and focused his attention on, doing evidence-
based work – that is, to only implement and initiate health promotion services that
are evidence based. He says the following about himself:

I am more the kind of guy . . . well I live in [a city far away from his job], but I applied
for this job because I thought it was exciting. [. . .] I am very focused on evidence
because I want us to make the most out of the citizens’ money [paid through taxes to
the municipality], and that is my driving force. So, I am trying to be critical about
what services we should provide. But often, the local politicians believe that if some
74 Public Policy and Administration 33(1)

young children [belonging to a minority group] have a problem with overweight, for
example, then we need to help them by offering an individually oriented service . . . but
then I say: ‘Is it really helping them, to give them something we know—at least from
the knowledge we have now—might not have any effect?’ That is what we have to
consider; do we help people by offering them a service that we know will not be
effective in the long run? Is that help? Is that doing something about it? [. . .] I believe,
if we implement those initiatives that are not evidently efficient, that is just as bad as
doing nothing—actually, it is worse because we are wasting the citizens’ money.

Holding this belief, Michael especially wants to make sure that the initiatives are
cost effective. What Michael does then is to analyse each suggested service pro-
posed in the guidelines according to his set of standards for what an effective
service is. He is very well aware that by so doing, he is somewhat re-doing the
work DHMA did when it made the guidelines, and he says:

That is crazy, right? But given the knowledge I have, and in my position as a health
consultant, I would be very sad to say, ‘‘Okay, well let’s just pretend this is good just
because it is what DHMA says we should do’’. Then I would not be able to look at
myself in the mirror and feel that I am doing a good job.

To exemplify, he describes a situation where his analysis of one of the guidelines

served as the argument for ending an existing health promotion service, even
though it was suggested in the guidelines, because his analysis showed that this
specific health promotion service was not based on solid evidence. He uses this
example to justify his concerns and beliefs when he says the following:

That is why it is so important that we do this work. I have also considered if I should
lower my income and do a PhD in order to show what we [in the municipal health
departments] are confronted with. Right now, this work [trying to raise awareness
among other municipal health consultants to make them more than unreflective oper-
ators] is something I also do in my leisure time, because I just feel it is extremely
important. But if that is what it takes, it is okay.

In other words, Michael feels a moral obligation to ensure that the health promo-
tion initiatives they implement are cost effective and optimise the conditions for the
majority of the municipality’s citizens. In order not to compromise his values,
he even goes as far as conducting what he himself terms ‘civil disobedience’,
when he deconstructs the guidelines – that is, when he ends and suspends
recommended services and tries to convince local policy workers from other muni-
cipalities to be more reflective in making decisions about implementing the guide-
lines. Nevertheless, Michael keeps emphasising that he would like our
conversations to be anonymous. Furthermore, his wish to arrange our meetings
away from his workplace can be interpreted as a means of constructing a neutral
site where he can openly describe how he handles the health promotion guidelines.
Wimmelmann et al. 75

This illustrates a man who is very well aware that he is acting against the social
norms and expected behaviour of a local policy worker in public health promotion.
Yet he is so passionate about his work that his moral beliefs and values trump
those socially normative concerns when he rebelliously deconstructs and acts
against the intentions of the guidelines. In that sense, he is utterly altruistic.
So far, we have met two local policy workers, who are in striking opposition to
each other when it comes to complying with the guidelines. However, as we will see
in the following, the implementation of the guidelines is not only a decision con-
ditioned by what one believes is one’s professional and/or moral obligation.
Rather, we will see a variety of professionally related experiences and beliefs that
affect the decisions and practices of implementation.

Louise: The reflective insider

Meet Louise. Previously Louise worked at DHMA, and, according to her, this
made her reluctant to act on the recommendations from DHMA. She explains
as follows:

I know how they work in the DHMA. It is not only scientific neutral truths they
publish—there are many different agendas, and not all of them concern evidence. If
the literature supports their ideas and beliefs, they do not critically assess the under-
lying evidence [. . .] And I know that everything that comes from the DHMA is
negotiated. Before they publish anything, it has to go through various filters, where
something is removed and other things are added. Knowing this, I take their recom-
mendations with a grain of salt.

Louise’s previous job in DHMA has formed her current attitude, not only towards
the scientific quality of these guidelines but in general towards DHMA. She
explains as follows:

Because I used to work there [at DHMA], I know how they think of the [people
working in the] municipalities . . . they think ‘they [the health administrations in the
municipalities] need a helping hand because they do not have people who can do this
work’. And maybe yes, we do not have all the time in the world for it, but we certainly
know how to do it, and we thus also know when the quality is not good enough. And
this work [the guidelines] is just too simplified [. . .].

As such, Louise’s scepticism is also related to the knowledge logistics inherent in

these centrally issued guidelines; according to such logistics, knowledge flows in a
supply chain from the experts to the users of supplied knowledge and thereby casts
the local policy workers as neutral operators. Given her previous experience at
DHMA, she is especially provoked by this role. As we learn, Louise emphasises
the municipalities’ and the local policy workers’ local government mandate and
their right to self-determination. As such, Louise does not fit into the knowledge
76 Public Policy and Administration 33(1)

supply chain as a neutral user of supplied knowledge (Markussen, 2014). Rather,

she is provoked by her earlier professional experience, and those feelings manifest
in a reflective attitude towards the guidelines and to any announcements from
DHMA. Louise believes that different agendas are in play when DHMA publishes
guidelines, and thus she closely scrutinises the guidelines before endeavouring to
implement them. She also indicates that she is more reflective in her use of the
guidelines than many of her colleagues in other municipalities when she says the
following:

The national discourse is way more religious about those guidelines, in the sense that
the goal is implementation for the sake of implementation. [. . .] when I have been to
some of those workshops [held to support the municipalities in the implementation of
the guidelines], I have taken a reflective and nuanced approach and been critical of
them; I do not just want to implement all these things and make the guidelines the
agenda itself just because the DHMA tells us that these initiatives are the best things
to do. Rather, we [the health administration in this municipality] work with our own
agenda, and if we can use anything from the guidelines to achieve that, we will do
so—but only if it makes sense for our own agenda. The unreflective discourse that
otherwise surrounds those guidelines—that has the goal of complete implementation
for the sake of complete implementation—is worrisome, rather worrisome, I believe.

As we see, Louise’s past professional experience of working in a policy-making

institution gives her insight that strongly affects her reaction to the guidelines.
However, as we will see in the following, it is not only previous professional experi-
ences within the field (in this case, public health promotion) that might influence
the local policy workers’ reasoning and (re)actions regarding a set of guidelines;
professional experience in other fields also profoundly influences the mind-set of
the local policy workers.

David: The innovative communicator

Meet David. After university, David started his career as a consultant in a manage-
ment-consulting firm in the private sector. Subsequently, he shifted to the public
health sector, and he has been employed in this municipality’s health administra-
tion for the past four years. He is not concerned with the guidelines’ (lack of)
evidence base. Actually, he claims the following about the lack of solid evidence
in the guidelines

[It] has no implications for the decisions regarding implementation because you
cannot measure everything. The conditions for health promotion services are that
we know very little about their effects, because lots of things influence their effective-
ness. But that does not change the fact that we will have to do something about it. So,
we have to be pragmatic and choose a strategy. And then we just believe in the good
intentions of it.
Wimmelmann et al. 77

In the case of the guidelines, David has employed a profound strategy. Each month
in the year is dedicated to a specific health promotion package (the guidelines
consist of 11 packages), where the particular package receives a public relations
(PR) focus. For example, in the case of the health promotion package for physical
activity, the health administration plans events, such as outdoor physical exercise
workshops, and spots on the local radio station concerning the existing physical
activity initiatives in the municipality.
In line with acknowledged ideas regarding health promotion development
(Laverack, 2004; Talbot and Verrinder, 2009), David believes that the potential
of health promotion initiatives is stronger when they are grounded in the needs and
wishes of the target group. Holding this belief, David uses communicative strate-
gies to raise awareness about these health topics among the citizens. He explains
this by giving an example relating to the health promotion guideline focusing on
sun protection. He states the following:

If parents hear about means of sun protection on the radio, for example, they will ask
for these services in their children’s institutions. Then the institutions will ask us for
advice and services, and we will suggest some of these initiatives. By so doing, we turn
the approach around, so the institutions now realise their need for a policy on sun
protection. Hopefully, they will then feel ownership of the policy and the related
initiatives, instead of the initiatives being something they are told to do, as doing
this is often unproductive and creates resistance.

In other words, David reconstructs the guidelines from indicating a top-down

approach to representing a bottom-up approach. As such, he implies that these
guidelines targeting the municipal administration(s) cannot solely be enacted as an
internal municipal administrational working tool (as is the case in most of the
municipalities we have investigated); they need to be linked to the initiatives’
target group, to the citizens. In order to do so, he emphasises communicative
efforts as an essential part of public health promotion. Actually, David claims
that ‘it is meaningless not to incorporate and emphasise as well as prioritise
resources to the PR part of health promotion’, and it makes absolutely no sense
to him why the PR and communicative efforts are not prioritised in the other
Danish municipalities. Yet those communication efforts do not merely serve to
turn the approach around; they also serve a financial purpose. ‘Doing municipal
health promotion is also a matter of attracting attention and financial resources’,
David explains

If no one knows what we are doing, we will not attract any resources. If we instead
are good at creating the best possibilities for our citizens to make healthy choices,
and if we are good at narrating and publicly communicating our stories of success,
we [the health administration] will be prioritised when the financial allocations are
discussed, because all local politicians are interested in creating a successful
municipality.
78 Public Policy and Administration 33(1)

He explains that communicating the guidelines explicitly to the citizens also serves
as a means of making the municipality’s other administrations attentive to health
promotion. He proudly shares his belief that he, ‘in all honesty, [has] succeeded in
branding those guidelines as ‘‘the final truth’’ about health promotion in munici-
palities’. In other words, David is not as excited about the content of the guidelines
as he is about the awareness the guidelines can create. As such, he shows an
extraordinary joy for the guidelines because he can use them to brand the health
administration and its services to make this area prioritised and efficient. To do
this, David strategically uses the guidelines as a tool to foster and promote his and
this municipality health department’s ideals and goals regarding awareness and PR,
and thereby asks not what he can do for the guidelines, but what the guidelines can
do for him. Doing so, we sense his emphasis on optimising the internal cross-
administrative engagement in health promotion by communicative means – an
acknowledged strategy (Iyer and Israel, 2012) often applied by management
(Ruck and Welch, 2012).
According to David, his background in management consultancy has sensitised
him to transfer management strategies and communication to the world of muni-
cipal health promotion. In this way, and in regard to common municipal health
promotion strategies, David is quite innovative – he uses his experience from the
world of management and applies this to municipal health promotion to appeal to
the local politicians, as they make many of their decisions according to business-
related arguments, such as finance, effectiveness and marketing.

Linda: The experienced strategist

Meet Linda. Linda accepts as true that we have to think at a structural level in
order to undertake effective health promotion. This implies that all the other
administrative areas in the municipality are engaged in the work as well.
However, during her years working with health promotion in a municipality, she
has encountered significant challenges in terms of making health promotion part of
the agenda in other administrative areas. Given her experience of those challenges
being ever-present, she believes those guidelines are the best material for conduct-
ing health promotion in the municipality. Nonetheless, she has no intentions of
implementing the guidelines, because she does not believe that it is realistic, or
makes sense, to enact the guidelines as a prescriptive list of services to which the
municipality should conform.
Linda has learnt from previous experiences that the other administrative areas
protest vigorously when definite health promotion matters are imposed on them.
She describes her work like this

To me, the work I do to do health promotion at the municipal level is, above all, to do
work on the attitudes towards health promotion in the other administrative areas. We
have to convince them to take part in this work, and we have never before had such an
excellent opportunity to do so.
Wimmelmann et al. 79

As such, Linda’s view of policy work resembles that found in other studies on
policy work (Adams et al., 2015). Her work with health promotion is then not
merely a matter of deciding upon or initiating specific projects and services. Rather,
she believes her work is that of forming the other administrative areas’ perceptions
of public health matters, so they become something the other administrations will
consider, prioritise and incorporate when they, for example, plan their infrastruc-
tural affairs. In order to do so, she uses the guidelines strategically, and she
describes them as a ‘gift’ from DHMA. At Christmas time, she literally gift-
wrapped the health promotion guidelines, attached a big red bow to them and
sent them to the municipality’s other administrative areas along with an invitation
to attend a meeting. However, it is not as if she does not initiate and/or organise
health promotion services in the municipality. She does. She explains as follows:

[The guidelines] serve as a means to pave the way and clarify which specific target
groups and arenas we should work with. But from there we go our own way, because
health promotion depends on the context in which it occurs. So, we take inspiration
from the guidelines, but we contextualise the recommended services: we modify and
integrate them with our existing practices.

As such, the services, which she initiates are not grounded in the guidelines – they
are grounded in her belief in the municipality’s existing health promotion
initiatives.
In opposition to Michael, Linda makes no effort to conceal her non-implemen-
tation of the guidelines – that is, she only employs the guidelines strategically, as a
means to foster collaboration across the administrations. Though she is acting
somewhat against what is expected from her, she explains that she is confident in
her decisions because she has an entire lifetime of experience of doing municipal
health promotion.

Discussion
By proposing a typology of local policy workers and disclosing situations in which
the local policy workers’ reasoning and enactments of the health promotion guide-
lines related to the centrally issued guidelines in nothing but name, this article
spotlights the human actors and individuality in implementation practices. As
the local policy workers consciously related their decisions about the implementa-
tion of the guidelines specifically to professionally related experiences (such as
previous jobs, actions or strategies), we found that the local policy workers’ pro-
fessionally related experiences was a consistent theme in our interviews. As such,
our findings relate closely to Sandfort’s (1999) findings in her study of welfare
reform at the frontline. The study showed that frontline staff in the public bureau-
cracy draw on past relations, daily experiences and clients’ stories as sources of
evidence when they assess the organisations with which they are mandated to col-
laborate (Sandfort, 1999). Our study contributes hereto and shows that such
80 Public Policy and Administration 33(1)

professionally related parameters are not exclusively affecting the frontline staff in
policy implementation. Professionally related experiences too affect the interpret-
ation and reaction of local policy workers, who work with the local government’s
strategy, implementing and assigning the local priorities and managing as well as
shaping the local services.
Grounded in our empirical data, we developed our typology to illustrate the
complexity in the group of ‘local policy workers’. Though we were greatly inspired
by Lipsky’s (1980) grounding work on street-level bureaucracy, in which he pro-
poses structural factors that enhance local policy workers’ use of discretion in
patterned ways (Brodkin, 2012), we are not presenting our typology to propose
that these professional experiences cause a fixed pattern of implementation prac-
tices. In other words, we are not suggesting that the reported professionally related
experiences in this study always cause the specific implementation reasoning or
practices we have shown. We do, however, argue that these types do exist, and
that the local policy workers’ professionally related experiences influence their
reasoning and thereby their strategy for guideline implementation. For example,
we suggest that local policy workers with a previous position in the policy-making
institutions assess any material from such institutions with an extraordinary focus
on the intentions of it because they are familiar with the procedures in these insti-
tutions. Although ‘the reflective insider’ in this case was sceptical of the guidelines
because of her experiences as an employee in the policy-making institution, we do
suggest that the opposite can occur: that previous employment in the policy-
making institutions might make the local policy worker less sceptical because he
or she knows the procedures by which the material (in this case, the guidelines)
have been conducted. Moreover, we suggest that other local policy workers, often
those with a long history of experience in their current position, have faith in their
already existing health promotion strategies. They thus merely, and strategically,
deploy centrally issued guidelines in ways the guidelines support and improve the
local policy worker’s existing strategies. Doing so is a strategic means to affect the
individual local policy workers’ conditions for doing his or her job. Another type of
local policy worker is the one coming to municipal (health promotion) adminis-
trations from other sectors (e.g. more traditional business-related areas). Bringing
their previously used business perspectives and modes of operating into municipal
health promotion, they innovatively deploy the guidelines. Contrary to ‘the experi-
enced strategist’, ‘the innovative communicator’ thinks in terms of the municipal-
ity’s wider agenda and deploys the guidelines as means to enhance the overall
strategy for the municipal health promotion. These local policy workers are
driven by optimisation and business development. We do however also see that
other local policy workers are driven by other, often moral, principles. Those
principles may be variously grounded, e.g. in educational traditions, personal ideol-
ogy, etc. For those local policy workers, and in order to align their working pro-
cedures with their moral beliefs and principles, (to some degree) the end justifies the
means. As such, they might even end up conducting rebellious actions, not com-
plying with the intentions or the norms. They do, however, know that their actions
Wimmelmann et al. 81

are not admired in public, and thus put effort into concealing their actions
(Wimmelmann, 2016). This generalised account of types of local policy workers
might seem to suggest that the decentralised organisation of health promotion
services should be reconsidered as none of the described types of local policy work-
ers act in line with the belief of an ideal local policy worker. However, though a
small minority in our study, we do wish to emphasise ‘the loyal operators’ who
disregard any personal (dis)satisfaction with the provided material in order to
complete their role as an operator.
To understand how and why the local policy workers’ professionally related
experiences come into effect – or more generally, how and why people in the same
positions receiving the same set of guidelines implement them variously – we intro-
duce the concept of translation as it is applied in critical policy studies (see Freeman,
2009; Freeman and Maybin, 2011; Kingfisher, 2013; Lendvai and Stubbs, 2007) and
organisational theory (Røvik, 2007), in terms of movement and transformation. In
so doing, we focus on ‘the practice of policy’ – that is, the process by which the
guidelines are received and implemented (Freeman and Maybin, 2011) – leaving
aside the theories of knowledge management (e.g. Alavi and Leidner, 2001) and
public service motivation (e.g. Gofen, 2014; Perry and Hondeghem, 2008).
We make two claims: first, that guidelines only have a social existence and
consequence(s) when they are called in words and converted into actions by the
local policy workers (Freeman, 2012; Winter and Nielsen, 2008) – that is, when
they are translated – and second, that the local policy workers recognise that they,
to some degree, can influence on the decisions taken (Winter and Nielsen, 2008).
When the guidelines travel in and between administrative units and workers, they
are received, read, decided upon and converted into action – that is, they are
translated and transformed into something else. Yet this is not an arbitrary trans-
formation; rather, it is a conscious change made by conscious choices (Freeman,
2009; Kingfisher, 2013; Lendvai and Stubbs, 2007; Yanow, 2004). However, trans-
lations of guidelines do not take place in a vacuum or in the ‘anything goes’ mode.
They take place in a certain setting – within a certain ‘hinterland’ (Law, 2004) of
existing practices, beliefs, previous experiences, devices, political agendas, institu-
tions, etc. The concept of hinterland could easily be considered as similar to ‘con-
text’. However, whereas context seems to represent a space of static ‘presentness’:
an (infra)structure of environment, framework or setting surrounding an event or
occurrence, a hinterland is both irreducibly there and exists only insofar as it exists
for something (Oppenheim, 2011). When the local policy workers narratively
include professionally related experiences to explain their current actions, they
connect situations across time and place. We introduce the concept of hinterland
here to emphasise that it is not merely what is present now – the context or the
current settings in the municipalities – but also what has previously been experi-
enced, that provides a specific yet dynamic topography of possibilities and con-
straints for the translation (‘hinter’ means behind in German). The point here is
that the current professional setting – that is, the municipality – cannot fully
explain the variation in implementation. Rather, a historical conjunction of
82 Public Policy and Administration 33(1)

contexts – as grasped by the concept of hinterland – provides a more comprehen-

sive explanation. In a nutshell, the concepts of translation and hinterland, then,
explain why people in the same positions receiving the same set of guidelines
implement them variously. Adding to this theoretical framework, our typology
explicitly illustrates that professionally related experiences, among other factors,
shape how the local policy workers perceive the ideological and practical possibi-
lities for, and constraints to, guideline implementation.
This article contributes to the literature on local policy workers in the following
ways. Most of the studies in this area introduce background data, such as age,
gender, educational background and professional background (Bo Smith-udvalget,
2015; Hansen et al., 2013), values (Vrangbæk, 2009) and job characteristics (Winter
and Nielsen, 2008), in an attempt to characterise the local administration as a
group and/or reveal the profile of an average local policy worker. The existing
literature, then, implicitly infers that the local policy workers’ implementation
practices – decisions and practices – can be understood and explained by those
variables. Whilst such surveys provide good descriptions of a certain group of
people and are useful for investigating patterns between norms, values and back-
ground variables, for example, they are less helpful in exploring the complexity that
nevertheless exists within a heterogeneous group of people. The causes suggested in
the policy literature for implementation failures are multitudinous (McConnell,
2015). Most of these failures have been connected to the characteristics of the
policies themselves (Peters, 2015) and a few others to the political or socio-
economic environment within which those policies are made (Peters, 2015) as
well as the characteristics relating to the institutions receiving the policies/guide-
lines, such as the internal organisational structure (Meyers et al., 1998; Olsen,
2013), resources and needs and organisational culture (Durlak and DuPre, 2008).
Yet another segment of the policy literature likewise suggests the personalised, and
arbitrary, treatment of policies and guidelines as a potential distortion in the imple-
mentation process (Goodsell, 1981; Meyers et al., 1998; Pesso, 1978). As we argue,
the latter is unavoidable: in real-world situations, the enactment of policies
and guidelines – the ‘know-how’ knowledge – invariably involves an element of
‘know-that’ knowledge or what Yanow (2004) calls ‘the local knowledge’.

Conclusion
First of all, this study reminds us that guidelines do not implement themselves –
they need to be activated in the sense of being put into action by people (Schofield,
2001) – and the people putting the guidelines into action are not merely ‘local
policy workers’ or a homogenous group of people. Rather, they come with different
professionally related experiences that affect the enabling and constraining frames
in which the guidelines are translated.
The inclusion of the concepts of translation and hinterland to our presentation
of a typology serves to explain and acknowledge the uncertainty, the centrality of
practice and the recognition of complexity (Freeman, 2009) that exist when people
Wimmelmann et al. 83

first de-contextualise and then contextualise guidelines (Røvik, 2007). Importantly,

if we take into account this movement of the guidelines – as being translated by local
policy workers within their own specific hinterland – then it becomes extremely
difficult, if not impossible, to neglect the benefits of a deeper exploration of the
people who constitute the group of local policy workers, to understand the variety
in their implementation of the guidelines (Jenkins, 2007). In regard to motivation
and perceived agency in public policy workers, Le Grand (2003: 17) argues that ‘the
realities of human motivation and agency are far too complex to be adequately
summarised by this kind of [typology] approach. [. . .] In fact, most human beings
are in all probability some combination [. . .], with different aspects come to the fore
in different circumstances’. Nevertheless, our typology illustrates the variety of local
policy workers and offers an alternative way of thinking about local policy workers.
The typology then serves as a tool for analysis and understanding policy implemen-
tation challenges. In other words, this article problematises the concept of imple-
mentation and draws attention to the personal characteristics of the people
implementing and to the fact that implementation processes are always tied to
local and individual contexts (Johnson and Hagström, 2007) and hinterlands.
Inasmuch as guidelines are increasingly used in Western countries as a soft form
of regulation (Timmermans and Epstein, 2010) to standardise the local govern-
ments’ public health practices (Rod and Høybye, 2015), it is worth considering who
the people giving life to those guidelines are. Taking the personalised treatment of
policies and guidelines as an unavoidable condition, we should engage and tackle
the local policy workers’ translations and implementation strategies in ways that
see them as productive, instead of focusing on varied implementation as a sign of
implementation errors or failures. In saluting and exploring the experiences causing
the variety, we will learn from the so-called ‘implementation failures’ and gain
indispensable insight into ‘the local knowledge’ – that is, the practice- and experi-
ence-based knowledge that has proven to work over time (Yanow, 2004).

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, author-
ship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, author-
ship, and/or publication of this article: The work is carried out as a part of the research
programme ‘‘Governing Obesity’’ funded by the University of Copenhagen Excellence
Programme for Interdisciplinary Research (www.go.ku.dk).

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