Implementation survey 2010 - Results

Report for respondents to the G-I-N survey on members’ implementation activities

October 2010

Summary

A survey of the implementation activities of G-I-N members was mooted at Lisbon G-I-N Conference in November 2009, and G-I-N implementation Steering Group designed and administered the survey during July – August 2010. The survey received 77 responses (there are 90 organisational members of G-I-N).  A wide range of implementation activities was reported, and there was a discernable gradient from frequent use of decision algorithms and brief formats of guidelines, to relatively rare use of social media and electronic clinical decision support. Respondents also expressed a desire for access to implementation ‘tools’, to repositories of ‘data’ on what works and for G-I-N to continue to support member networking and information sharing on implementation methodologies.

1. Background

A survey of the implementation activities of G-I-N members mooted at Lisbon G-I-N Conference, November 2009.

G-I-N Board ratified two aims for the survey in March 2010:

• To identify the range of guideline implementation activities G-I-N member organisations routinely undertake.

• To identify how G-I-N can help members with guideline implementation

2. Method

• Electronic survey (containing multi-choice and free text items)
• Population: Self-selecting respondents who are ‘knowledgeable’ of guideline implementation activities their organisations
• Sample frame: G-I-N membership list
• Email invitation sent 20 July 2010
• Reminder sent 11 August 2010

Main questions asked were:

Q1. “Which of the following guideline implementation tools, processes or strategies does your organisation currently produce, or plan to use, and which are best applied by intermediaries or end users?”

Response options (forced choice required between options ):

• Currently producing or doing
• Plan to produce or do within one year
• Plan to produce or do within five years
• Best done produced by intermediary
• Best done by end user
• Not sure

See at the end of this page for the list of implementation activities which respondents were asked to give responses on.

Q2. “Please describe additional tools, processes or strategies your organization uses to implement guidelines.”

3. Responses

• 77 individual responses from Respondents in 67 organisations (note there are 90 organisational members of GIN)
• 5 instances of 2 responses from one organisation
• 1 instance of 3 responses from an organisation
• 1 instance of 4 responses from an organisation

Results reported below include duplicate responses; these are valid as responses from self-selecting ‘knowledgeable’ respondents.

4. Results

No real discontinuity in frequency distributions below; every activity is either already used or planned by at least a minority of respondents. Suggests there is no very strongly shared view between respondents as to what is firmly appropriate vs. firmly inappropriate.

Frequency histograms

Current implementation activities.jpg

Current -blue- planned in 1 year -purple- or planned in 5 years -white- activities.jpg

Activities which respondents thought best done by guideline end user -blue- or by intermediary -purple.jpg

End user = a practicing clinician OR a healthcare service provider organisation

Intermediary = any other individual or organisation (includes for example all funding, policy, insurance or other agencies)

Frequency of Unsure response-blue- or non-response -purple.jpg

Other methods used by members:

“…link with other guideline developers on [similar] topics  - ensure consistency in message / recommendations”

“Motivating "quality circles" of early users; use this group to know more about barriers or supporting conditions.”

“Guideline / pathway integration” [currently working with telemedicine providers]

“Commissioning guides, including service specifications, benchmarking assumptions, a tool to compare local activity to the benchmark, governance and quality assurance information.”

Suggested supports for guideline implementation which G-I-N might provide to its members:

• Syntheses / links / ‘database’ / repository  of "best practice" information tools (including cost-effectiveness)?
• Provide a list of international people working in various implementation projects worldwide that are interested in being be networked with.
• Provide forum to ‘run hypotheticals’, stimulate innovative thinking and ideas on implementation
• Keep implementation of guidelines as a discussion topic at annual conferences..
• Promote what works through the G-I-N newsletter?

6. Conclusion

• All organisations are doing at least some of the activities we listed – and some others as well
• Discernable gradient from frequent use of decision algorithms and summary formats to rare use of social media and eCDS
• Wide range of views about what is intended, and who best to undertake activities, though this may reflect different roles of individual / organisational members of G-I-N rather than true disagreement.
• Most uncertainty about use of social media, podcasts / RSS / webcasts and about costing tools
• Desire for access to ‘tools’, repository of ‘data’ on what works; desire for for G-I-N to continue to and support member networking and info sharing.

Multichoice ‘implementation activity’ items.

Respondents gave a response of one of the following: ‘Currently producing or doing [this activity]’ /  Plan to produce or do within one year / Plan to produce or do within five years / Best done by intermediary /  Best done by end user / Not sure.

A response was required for each of the following items:

• Decsn algor / diag: Decision algorithms / diagrams
• Pract. summary: Publishing of summaries of guidelines for practitioners
• Mtgs with networks: Meetings with clinical and other networks for general discussion / promotion of a guideline
• Pat summary: Publishing of summaries of guidelines for patients / public
• Media / launch / presentations: Media activities, publication or conference presentations
• Chapter / section: Chapter or section in the guideline which specifically discusses implementation
• Training materials / media: Training materials / media
• Audit / performance measures: Audit tools or performance or quality measures
• Separate guidance re how to impl.: Guidance on how to implement guidelines in addition to the guideline document itself
• Standards: Performance or quality measures with normative statements about required performance
• ‘Implementability’ analysis: Full implementation plan: a detailed report setting out steps and costs of implementing a particular guideline (this could be at national, regional or local level)
• Change / QI projects: Set-up and management of practice- or systems-change projects (e.g. national quality improvement projects, regional or local clinical pathway development)
• Delivery of training: Delivery of formal clinical training on the guideline
• Webinars/ RSS / podcasts: Interactive media (e.g. webinars / web-meetings for practitioners, RSS, podcasts)
• Detailed implementation plan: Barrier / enabler analysis or other ‘implementability’ analysis to explore what will be required to implement a guideline
• Costing tools: Tools for calculating the cost of adopting guideline recommendations
• Facebook/Twitter/similar: Social networking tools (e.g. Facebook/Bebo/Twitter or other)
• eCDS: Clinical decision support software version of guideline (for computer-assisted application at the point of care)