Table 1 summarizes reported barriers and facilitators influencing implementation of clinical guidelines.
Categories and subcategories | Barriers | Facilitators |
|---|---|---|
Organizational resources | ||
Staff | Lack of time | Clear roles |
No agreement on need to use clinical guidelines | Included in decision-making processes | |
Emotional exhaustion | Sufficient time | |
Influence of prior experiences | ||
Workload | ||
Information overload | ||
Learning culture | Lack of learning culture | Promotes learning organization |
Leadership | A lack of dedicated time | Strong leadership |
Lack of investment from the organization | Active department chief | |
Guidelines not mandatory | Head of department supported the implementation | |
Lack of organizational strategy and skills | Effective organizational structures | |
Resistance to multi-disciplinary team | Empowering approach to learning | |
Concerns about resources | Multi-disciplinary implementation team | |
Lack of financial resources | Awareness of clinic attitudes and actions | |
Effective teamwork | ||
Dissemination | Lack of clear intervention goals | Supporting implementation |
No regular implementation meetings | Planning the implementation process | |
Guideline format | Access to guidelines tools and recommended clinical scales | |
Change clinical patterns | No measurement or tools for evaluation of care | Feedback on performance |
Audit used routinely | ||
Quality indicators | ||
Measuring 'before' in order to identify gap | ||
Facilitation | Lack of facilitation | External facilitation |
Academic outreach visits | ||
Driving local change | ||
Health care professionals' individual characteristics | ||
Attitudes and beliefs | Negative attitudes to clinical guidelines and new action | Positive attitudes and beliefs regarding guidelines and new action |
Perceived limited validity of guidelines | ||
Fear of loss of autonomy | ||
Fear of standardization of care | ||
Concerns about relevance of evidence to own patients | ||
Lack of internalization of guidelines | ||
Knowledge | Lack of research skills | Increased knowledge |
Lack of specialized training | ||
Perception of guidelines and implementation strategies | ||
Credibility of content | Change in recommendations | Increased accountability |
Overestimation of current care | ||
Awareness | Lack of familiarity with guidelines | Practitioner's awareness |