RT Journal Article
SR Electronic
T1 A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines.
JF Quality in Health Care
JO Qual Health Care
FD BMJ Publishing Group Ltd
SP 177
OP 183
DO 10.1136/qshc.8.3.177
VO 8
IS 3
A1 N T Moulding
A1 C A Silagy
A1 D P Weller
YR 1999
UL http://qualitysafety.bmj.com/content/8/3/177.abstract
AB Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies.