Emerging Practice Categories for Approach to Guideline Adoption and Implementation
| Characteristics | Example Quotes |
|---|---|
| Clinician-directed: Clinicians independently decide which guidelines to implement and how to implement them. | |
| Learning New Evidence: Clinicians learn on their own with limited formal structures for clinicians or staff to learn from one another. Topic Leads: No identified clinician or staff leads to make decisions for the practice. Practice-Wide Updates: Information may come from the practice or health system level, but there is no expectation for all clinicians to abide by the same clinical guidelines. Implementation Process: Done by individual clinicians. | “I usually kind of decide that on my own based on what I’ve learned up to this point in time and I’ll search my own experiences. I would be the first to say that at times I’m kind of just a late adopter for certain things even though there may be a guideline out. Sometimes I don’t always agree with it” (Clinician) |
| Practice-directed: Practices collectively decide which guidelines to implement and how to implement them. | |
| Learning New Evidence: There are structures within the practice through which clinicians can share knowledge with one another. Topic Leads: Individual clinicians or staff leads with topic expertise lead the practice in a uniform clinical approach. Practice-wide Updates: Information from the health system is discussed among everyone in the practice, but ultimately the practice has guideline decision-making autonomy. Implementation Process: Large emphasis on workflow with clinicians and staff working together to determine the best workflow process. | “We have two meetings a month within our clinic where providers get together for just under an hour. One is a peer review meeting. There’s always education that’s part of that. And then we have a second meeting that’s more focused on workflows but oftentimes that dovetails with education and being made aware of guidelines.” (Clinician) “The EHR, I mean we have these quality guidelines now that kind of drive me insane. They’re helpful to a point. They kind of make me crazy too because I don’t feel like those are as up-to-date as we are maybe.” (Practice Leader) |
| Health system-directed: The health system decides which guidelines to implement and how to implement them and then informs practices and clinicians. | |
| Learning New Evidence: The health system regularly updates clinicians and staff about new clinical guidelines. Topic Leads: Clinicians and staff serve on health system committees to make system level changes. Practice-wide Updates: Evidence changes are reviewed by the health system, often a quality committee, before making routine changes to practice. Implementation Process: The EHR is utilized heavily to define the workflow. | “I chair our quality committee; so, if it’s something that’s really new or different, then generally the quality committee will take a look at it and we’ll talk about, you know, is there something we need to do? Should we advertise this? If it’s something really different from what the old guideline was, usually the quality committee will talk about it and publicize it.” (Clinician) “We just made it happen. It wasn’t open for discussion to be honest. There’s not a lot open for discussion as far as changes go. We just say this is how it’s going to be; just grumble and move forward.” (Practice Leader) “we do have a lot of standing orders and we do have a lot of adult immunizations, things that the nurses can do on their own…” (Practice Leader) |
EHR, electronic health record.