Policies, guideline implementation and practice change – how can the process be understood?

Abstract

Politics and policy: It is important to understand why, in the translational continuum from pilot research and randomised controlled efficacy trials to roll-out programmes and routine effectiveness studies, some service innovations are taken up by health service purchasers and providers, while others are not. Why do some innovative interventions or models of care get to the stage of implementation, while others fail to be funded?

Evidence, knowledge, implementation: glossary of terminology

“…Salvador Carulla et al (2017) consider guidelines as implementation tools, and therefore better implementation is seen as a consequence of better guideline development. Becker et al (2017) consider guidelines as tools to be implemented, and therefore better implementation is seen as a consequence of better knowledge about the efficacy of different guideline implementation strategies.…”

“…IMPLEMENTATION = Implementation is defined as a specified set of activities designed to put into practice a program. Becker et al (2017) argue that current knowledge about how guidelines should be implemented is sparse and inconclusive in mental health care. This is indeed the case.…”

“…Although single studies provided initial evidence that implementation of treatment guidelines may achieve small changes in mental health practice, it highlighted a gap in knowledge, with scant information available for people with mental health problems, health professionals and policy-makers. This aspect is of paramount relevance, especially if guidelines are conceptualised as tools to be implemented, as suggested by Becker et al (2017), because it means that we still do not know which guideline implementation strategies are effective and cost-effective in the long-term. In other fields of health care, interventions that may promote guideline use include educational activities, social engagement, clinical support systems, incentives, audit and feedback exercises (Gagliardi, 2012).…”

“…This aspect is of paramount relevance, especially if guidelines are conceptualised as tools to be implemented, as suggested by Becker et al . (2017), because it means that we still do not know which guideline implementation strategies are effective and cost-effective in the long-term. In other fields of health care, interventions that may promote guideline use include educational activities, social engagement, clinical support systems, incentives, audit and feedback exercises (Gagliardi, 2012).…”

“…Becker et al . (2017) consider guidelines as tools to be implemented, and therefore better implementation is seen as a consequence of better knowledge about the efficacy of different guideline implementation strategies.…”