Lessons from experienced guideline implementers: attend to many factors and use multiple strategies

Area of Science:

• Healthcare Management
• Clinical Practice Improvement
• Health Services Research

Background:

• Previous clinical guideline implementation studies primarily focused on individual clinician behavior change using single interventions.
• Limited attention has been given to the situational context and its impact on implementation success.

Purpose of the Study:

• To identify contextual variables and implementation strategies perceived as important by experienced clinical guideline implementation leaders.
• To assess whether implementation success can be achieved using only a single implementation strategy.

Main Methods:

• Interviews with 12 experienced clinical guideline implementation leaders to identify key variables and strategies.
• A modified nominal group/Delphi process was used to rate identified variables and strategies.
• International expert reactions were obtained to provide additional perspective.

Main Results:

• Eighty-seven variables and 25 strategies were identified, grouped into six categories: organizational capabilities, infrastructure, implementation strategies, medical group characteristics, guideline characteristics, and external environment.
• All six categories were deemed important by the panel.
• Variables related to the medical group's capacity for planned change were rated as more critical than guideline or external environment characteristics.

Conclusions:

• Implementation efforts targeting individual physicians with single strategies are unlikely to succeed.
• Successful clinical guideline implementation requires multiple strategies that consider the guideline, practice organization, and external environment.