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Cited by 259Clinical practice guidelines implementationHealth Policy Implementation ScienceHealth Sciences Research and Education

Lessons from Experienced Guideline Implementers: Attend to Many Factors and Use Multiple Strategies

Solberg, Leif I., Brekke, Milo L., Fazio, Charles J., Fowles, Jinnet, Jacobsen, Diane N., Kottke, Thomas E., Mosser, Gordon, O’Connor, Patrick J. +2 more·2000·The Joint Commission Journal on Quality Improvement
DOI 10.1016/s1070-3241(00)26013-6
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Abstract

Background Studies of clinical guideline implementation have focused almost entirely on changing individual clinician behavior with single intervention strategies and without much attention to the situational context. The goal of this project was to learn from clinic leaders, seasoned in the guideline implementation process, what contextual variables they viewed as important and whether implementation success could be expected if only a single implementation strategy was used.Methods In 1998, 12 people with extensive experience in leading clinical guideline implementation were identified who were thought to have particularly keen insight into the process. They were interviewed to generate variables they considered important, as well as strategies they considered effective when used appropriately. A modified nominal group/Delphi process was then used for rating these variables and strategies, and the reactions of international experts were obtained to add perspective to this information.Results Eighty-seven variables and 25 strategies were identified, clustering in 6 categories (ranked in order of importance by the panel): organizational capabilities for change, infrastructure for implementation, implementation strategies, medical group characteristics, guideline characteristics, and external environment. All six categories were considered to be important, key, or essential by the experienced implementers, although variables within a medical group that directly affect its ability to undertake planned change were rated as much more important than either guideline characteristics or the external environment.Discussion Although the opinions of those experienced in the process of guideline implementation are primarily of value for generating hypotheses, panel members believe that implementation efforts focusing on the individual physician with a single strategy are unlikely to be successful. Rather, implementation efforts must use multiple strategies that take account of multiple characteristics of the guideline, practice organization, and external environment.

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  • The empirical evidence for the effectiveness of multifaceted strategies has been mixed.

    “The empirical evidence for the effectiveness of multifaceted strategies has been mixed, because early research touted the benefits of multifaceted strategies [98,99], while a systematic review of 235 implementation trials by Grimshaw et al. found no relationship between the number of component interventions and the effects of multifaceted interventions [100].”

    From Writing implementation research grant proposals: ten key ingredients (2012) · cites this paper as [99]

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Authors
Solberg, L. I., Brekke, M. L., Fazio, C. J., Fowles, J., Jacobsen, D. N., Kottke, T. E., Mosser, G., O’Connor, P. J., Ohnsorg, K. A., & Rolnick, S. J.
Affiliations
  • HealthPartners (US)
  • Joint Commission (US)
  • International Computer Science Institute (US)
  • Mayo Clinic (US)
Corresponding author
Solberg, Leif I.
ORCID
Venue
The Joint Commission Journal on Quality Improvement
Publisher
Elsevier BV
Published
2000-04
Volume
26
Issue
4
Pages
171-188
ISSN
1070-3241 (ISSN-L)
DOI
10.1016/s1070-3241(00)26013-6
OpenAlex
W2397003148
Cited by
259
References
28
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2022: 1 · 2021: 5 · 2020: 6 · 2019: 8 · 2018: 6 · 2017: 1 · 2016: 6 · 2015: 10 · 2014: 11 · 2013: 12 · 2012: 11
FWCI
17.58
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Joint Commission Journal on Quality Improvement (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
guideline implementation, implementation strategies, organizational infrastructure, external environment, clinician behavior change, expert consensus, Delphi method, nominal group technique
MeSH terms
Delphi Technique, Group Practice, Planning Techniques, Focus Groups, Practice Guidelines as Topic, Total Quality Management, Guideline Adherence

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