How to implement guidelines and guides in municipal healthcare

The focus of the summary has been guidelines, since little research has been done on the implementation on other types of national guides for healthcare. Guides are included, however, there is less research on the implementation of these compared to guidelines.

These topics are covered in this summary of knowledge:

• Theoretical frameworks that can be used as a guide for the process of implementing  guidelines/guides
• What acts as barriers and promoters for the implementation of guidelines and guides in the health services
• Attitudes towards guidelines/guides and how it affects and implementation
• Which methods have been used to implement guidelines and guides
• The results of implantation work that has been done

The target audience for this summary of knowledge is everyone who works with implementing guidelines and supervisors in the municipal health and care service.

Key development features

The municipal health and care sector is a large and complex field, and is given more and more tasks. This means that there are many guidelines and guides to deal with. These covers many different areas, from national professional guidelines for dementia, to national guides for the follow-up of persons with large and complex needs. 

In Norway, it is mainly the Directorate of Health and the Institute of Public Health that develop national professional guidelines and guides for the health and care sector. The purpose of these is to provide guidance for what is considered best medical practice. They are also responsible for contributing to the implementation of these guidelines and guides. This is done through resources such as national and regional competence centers, such as the Development Centers for Nursing Homes and Home Services (USHT).

Despite the Directorate of Health and the Institute of Public Health having the responsibility to contribute to the implementation of guidelines and guides little has been done in this regard. The Norwegian Directorate of Health has set some minimum requirements for the implementation of guidelines and guides, which include, among other things, that both short and long versions of guidelines and guides must be available. In 2012, it was only for a small number of guidelines and supervisors that even the minimum requirements for implementation had been met by the Directorate of Health.

Having to implement national guidelines and guides at a local level is a challenging task. This has led to several different frameworks and models being developed that can be used as guides to plan and carry out an implementation, or provide an overview of what can influence the outcome of the implementation. Relevant models and frameworks that have been used both in Norway and countries with comparable healthcare services are described in this summary.

Main findings

1. Little research was retrieved regarding the implementation of guidelines and guides in the municipal health and care sector specifically, more research has been carried out in the specialist health service.
2. Implementation methods that have resulted in successful implementations are often a mixture of teaching, meetings and workshops and gatherings. Despite this, mostly passive methods are used in the Nordics, such as publishing guidelines and guides online and sending them by post.
3. What are highlighted as barriers to adopting guidelines and guides locally are pressure from several quarters, a lack of local motivation and resources, and the experience that the developer is not familiar with clinical everyday life. Other barriers are unclear guidelines/guides, that the effort made to implement them is greater than the gain, and the knowledge base for the guideline/guide is not perceived as relevant for practice.
4. What is highlighted as promoters to adopting guidelines and guides is to allow employees to participate in relevant projects and support implementation, to have practice-based training and to return the results of implementation research to the departments. Another promoter highlighted is the ability to incorporate guidelines and guides with the patient’s/user’s preferences.

Conclusions

The knowledge summary shows that in order to succeed with a local implementation of national guides and guidelines, it is important to:

• plan the work well, and use a model or a framework in both the planning and execution of the implementation.
• use resources such as competence centers and their networks where relevant.
• use active methods such as teaching, workshops, and gatherings, and make the educational components practical.
• evaluate the results of the implementation, and give feedback and guidance to the employees about the work that is done in making a guideline or guide a part of everyday work.