Paper short abstract:

While local health departments often seem to comply with national health promotion guidelines, this case-study of the Danish health promotion guidelines illuminates how the local policy workers, secretly, reshape the guideline monitoring tools to perform ‘guideline compliance’.

Paper long abstract:

Guidelines, and the related practices to monitor the compliance with them, are increasingly used as means to regulate local authorities towards certain practices. This exploratory case-study takes the Danish national health promotion guidelines as a case and shows how local policy workers do not merely implement guidelines as proposed. The case study was conducted during a year-and-a-half through on-going contact with the local policy workers in a Danish municipality's health department. Data was gathered using a variety of (in)formal qualitative methods and uncovers both official and unofficial beliefs and practices.

Great advisory and financial efforts have been expended to ensure success (understood as a high degree of implementation) of these guidelines. According to the issuing authority of the guidelines, the Danish Health and Medicine Authority (DHMA), the guidelines are a story of success that is worth extended investments and continuation. Yet, this case-study tells another story of a local implementation of the health promotion packages-a story of deliberate concealment strategies, creative practices, and different performances. Applying a dramaturgical framework, it illustrates how the local policy workers challenged and reshaped the expert-led monitoring practices used to monitor their guideline compliance to front-stage some implementation practices and back-stage others. By so doing, 'guideline compliance' became a deliberate performance made by the local policy workers rather than the result of acting in accordance with the guidelines. Forward, when studying local guideline compliance, we must also consider it as a staged performance in which deliberate techniques are used to produce, and manage certain impressions of compliance.