Guideline Central Blog

Now that you’ve identified the barriers and prioritized specific interventions as discussed in our previous article on Step 4: Determining Interventions To Mitigate The Identified Barriers, it’s time to begin looking at actual implementation. This includes following through with the previous plans you’ve put in place, and the distribution of various resources to support your identified interventions.

Specific activities carried out in this stage:

• Maintaining communication with stakeholders and securing continued buy-in
• Providing tools, resources, mentoring/coaching, and similar to support specific interventions and implementation efforts as a whole
• Adapting for local settings where appropriate.
• Ongoing monitoring of outcomes, including implementation outcomes and overall patient outcomes. Also, using data and feedback mechanisms to inform ongoing improvements (discussed in greater detail in our next post with the final steps.

Local Adaptation

Consider localization of the guidelines to increase likelihood of adherence. Implementation requires management of many interacting elements in both internal and external environments. As a result, all implementation plans will need to walk a balance beam between maintaining fidelity to an intervention’s design and needing to consider and adapt implementation plans to a specific organization’s context and conditions. In reality, due to natural variation in real world contexts, it is almost impossible to apply an implementation plan with 100% consistency. For this reason, it’s important to identify and understand which components of the plan are “core components”, which should be delivered as-is with total fidelity, and which components can/should be adapted for the local conditions or workflows. An example of an acceptable adaptation: if guidelines recommend statins, and you have preferred statin  medications on formulary, integrate that into your implementation strategy to make it more relevant and actionable for your organization.

Communication

Regular communication is critical to implementing the plan you’ve developed to this point. This includes engaging implementation teams, individual clinicians, IT, business teams, and more. Both formal and informal methods of communication should be considered to optimize effectiveness of the program. It’s also important to take into account any potential implementation “champions”, as well as stressing the importance of coaching and mentoring, especially between more experienced and newer staff.

Providing Resources to Support Interventions

In addition to frequent communication amongst stakeholders, the distribution of various tools and resources have been shown to improve implementation results. Examples of tools that can be developed or sourced to support the identified interventions:

• Checklists and reminder cards
• Access to the clinical guideline(s) in multiple formats for various workflows and scenarios
• Summarized key takeaways from the specific interventions you are looking at implementing
• Focused learning activities, clinical case reviews, and quizzes for key stakeholders to support retention of the information in the clinical guideline
• Slide sets, infographics, and other bite size methods of presenting key information visually
• Putting performance improvement measures in place
• Computerization of the clinical guidelines, including logic with actions and decision variables, to support clinical decision support use cases within your EHR
• And more

Common pitfalls to avoid during the implementation process include:

• Lack of clear and consistent communication among stakeholders
• Unclear goals
• Lack of support given to stakeholders to support implementation of specific intervention(s)
• Inconsistent data collection across time to measure progress
• Not achieving buy in from leadership
• Setting unrealistic expectations
• Lack of local setting and/or workflow adaptation

Stay tuned for our next post as wrap it up with the final steps in our Guideline Implementation Series highlighting the necessary measures, evaluations and optimizations. Sign up for alerts and stay informed on the latest published guidelines and articles.