Brennan, C orcid.org/0000-0002-5258-8497, Greenhalgh, J orcid.org/0000-0003-2189-8879 and Pawson, R (2018) Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. Journal of Evaluation in Clinical Practice, 24 (1). pp. 105-116. ISSN 1356-1294
Abstract
Rationale
Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by “a guideline” making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries.
Methods
This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, “thematic reviews,” which aggregate and enumerate the “barriers and facilitators” to guideline implementation. It then outlines a “realist synthesis,” focussing on testing the “programme theories” that practitioners have devised to improve guideline uptake.
Results
Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change.
Conclusions
Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | (c) 2017, Wiley. This is the peer reviewed version of the following article:Pawson, R, Greenhalgh, J and Brennan, C (2017) Guidance on Guidelines: Understanding the Evidence on the Uptake of Healthcare Guidelines. Journal of Evaluation in Clinical Practice , which has been published in final form at https://dx.doi.org/10.1111/jep.12734. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. |
Keywords: | healthcare guidelines, realist synthesis, complex systems, research utilisation |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Psychiatry and Behavioural Sciences (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research 11/1022/04 |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Feb 2017 16:39 |
Last Modified: | 19 Apr 2021 14:59 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/jep.12734 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:111909 |