Implementing clinical guidelines using quality improvement methods: An organisational analysis of three case studies in the acute medical setting
Clinical guidelines offer an ‘off-the-shelf’ synthesis of the best available evidence of effectiveness of interventions, providing recommendations or standards for clinical practice. The number of clinical guidelines has been increasing, especially in the UK, where production by the National Institute of Health and Care Excellence has accelerated in recent years. However, supporting clinical teams to effectively translate recommendations from clinical guidelines into changes in the delivery and organisation of healthcare and demonstrate subsequent improvements in clinical outcomes remains a challenge. Quality improvement (QI) approaches offer a potential strategy for supporting the translation of clinical guidelines into locally designed interventions and guiding their implementation.
This report describes the analysis of three initiatives in two hospitals in London that aimed to implement clinical guidelines in the acute medical setting. The initiatives were supported by the Collaboration for Leadership in Applied Health Research and Care for Northwest London to use a comprehensive approach to quality improvement to facilitate the translation of the clinical guidelines into care bundles or screening tools followed by their implementation. The analysis explores the practitioner and organisational barriers and facilitators to implementation using the Consolidated Framework for Implementation Research, which draws on a number of constructs, theories and approaches to implementation.
Outcome & Impact statement
The analysis identified a number of thematic facilitators and barriers including the availability of resources for implementation; the sustainability of change; senior leadership engagement and practitioner incentives. Through the analysis, a conceptual framework was developed that links the process of guideline translation and implementation to practitioner and organisational barriers and facilitators. The analysis also provided an opportunity to identify some high-level recommendations for acute hospitals, quality improvement specialists and health services researchers. It would be hoped that addressing these issues at an organisational level, coupled with a comprehensive quality improvement approach, may further support future implementation initiatives to deliver sustainable changes in clinical practice.
What happened next?
The project was exploratory work to examine the role of one type of mechanism that aims to improve clinical practice and the quality of healthcare in the acute medical setting, namely clinical guidelines. A further proposal has been developed to look at additional mechanisms for supporting the delivery of quality evidence-based acute care for patients with heart failure across the sector (northwest London).