Addressing implementation challenges during guideline development – a case study of Swedish national guidelines for methods of preventing disease

Abstract

BackgroundMany of the world’s life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.MethodsSeven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.ResultsThe study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.ConclusionsThis case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.

Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden

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“…First, broad agreement on purpose can contribute to raised motivation and organizational readiness among target users [ 26 , 27 ]. In this study, we found that health authorities decided to develop national guidelines to meet the challenges of growing antimicrobial resistance and variations in antibiotic use between hospitals.…”

Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses’ perceptions

“…According to Grol and Wensing ( 2013a ), the optimal point in time at which to adjust guidelines to suit an organization is during implementation. Constructing and marketing guidelines as flexible enough to suit difference between municipalities would likely facilitate their implementation (Richter-Sundberg et al, 2015 ).…”

“…According to Grol and Wensing's ( 2013b ) model, it has been concluded that these comprise the actual innovation; the practitioners; the clients; culture in the workplace; the economic, administrative, and organizational context; and the choice of strategy for the implementation and dissemination of the innovation. Accordingly, a Swedish study showed that guideline developers could benefit from an initial assessment of how the actual topic, the target context, and the stakeholders affected the implementation (Richter-Sundberg, Kardakis, Weinehall, Garvare, & Nystrom, 2015 ). In addition, a Canadian study found several barriers to the implementation of best practice guidelines into a public health setting, which were consistent with earlier research, such as time constraints, working in multidisciplinary teams, and system-level changes in leadership (Athwal et al, 2014 ).…”