Article type
Abstract
Background: The evidence-practice gap is a well-known problem in all healthcare settings. Despite the use of existing theoretical models to address evidence-practice gaps, sustainable implementation of guidelines often remains a challenge. When the guideline contains a higher level of complexity, it is likely that there is an increase in the intricacy of the implementation itself. In literature, the complexity of interventions is clearly described; however, the complexity within guidelines is less explored. It is important to understand this complexity to explore suitable evidence-based models to implement these guidelines.
Objectives: This study sought to identify the determinants of the complexity within guidelines and their implementation.
Methods: A working group was formed with 7 researchers and/or clinicians of varied healthcare backgrounds, each possessing a unified interest in the formulation and utilization of healthcare guidelines. They discussed possible determinants of complex guidelines during 2 consensus meetings. These determinants were then sent to an international group of 16 likewise stakeholders, using a 3-round Delphi procedure.
Results: 16 determinants were found pertinent to use in the Delphi procedure. The Delphi procedure confirmed the significance of 10 among these determinants.
The complexity of a guideline, and of its implementation, is affected when the number of components, settings, targeted behaviors, and stakeholders increase; when a gap exists with the reality of clinical practice; or when differences in education exist between end users. In addition, the level of collaboration required of the different end users, the scope of change, the level of evidence in the guideline, and the workload for the end users define the complexity within the guideline.
Conclusion: This study defined the determinants of the complexity within guidelines and their implementation. The defining elements will be used to look for suitable implementation theories and frameworks. In a subsequent study, guidance will be developed to assist clinicians in the selection of an appropriate implementation theory or model. Enhancing the understanding and application of evidence in a more efficient manner will invariably contribute to the improvement of patient care.
Objectives: This study sought to identify the determinants of the complexity within guidelines and their implementation.
Methods: A working group was formed with 7 researchers and/or clinicians of varied healthcare backgrounds, each possessing a unified interest in the formulation and utilization of healthcare guidelines. They discussed possible determinants of complex guidelines during 2 consensus meetings. These determinants were then sent to an international group of 16 likewise stakeholders, using a 3-round Delphi procedure.
Results: 16 determinants were found pertinent to use in the Delphi procedure. The Delphi procedure confirmed the significance of 10 among these determinants.
The complexity of a guideline, and of its implementation, is affected when the number of components, settings, targeted behaviors, and stakeholders increase; when a gap exists with the reality of clinical practice; or when differences in education exist between end users. In addition, the level of collaboration required of the different end users, the scope of change, the level of evidence in the guideline, and the workload for the end users define the complexity within the guideline.
Conclusion: This study defined the determinants of the complexity within guidelines and their implementation. The defining elements will be used to look for suitable implementation theories and frameworks. In a subsequent study, guidance will be developed to assist clinicians in the selection of an appropriate implementation theory or model. Enhancing the understanding and application of evidence in a more efficient manner will invariably contribute to the improvement of patient care.