Barriers and enablers to implementing an induction of labour guideline: A clinician survey.

Abstract

Clinical guidelines improve outcomes, but poor compliance with recommendations is common. Insight into perceived barriers and enablers to the implementation of guidelines can engage maternity care providers and inform strategies for effective implementation. To identify the perceived barriers and enablers to implementing the 2020 'Induction of Labour [IOL] in Aotearoa New Zealand; a Clinical Practice Guideline.' Electronic anonymous survey of clinical leaders in midwifery, obstetrics, and neonatology in New Zealand, from August to November 2021. Recruitment of participants was initially through provided lists of national clinical leads, followed by chain sampling. There were 32 of 89 surveys returned (36%). The most frequently identified enablers were implementation tools such as 'standardised IOL request form' and 'peer review process,' and administrative support and dedicated time. Six maternity hospitals already had peer review in place, whereby IOL requests that did not adhere to guidelines were reviewed by a multidisciplinary group of senior colleagues or peers, with individual feedback to the referring clinician. Attitudes in the form of 'existing systems, routines and culture' was the most frequently identified barrier, followed by external barriers such as 'lack of human resources.' Overall, few barriers were identified to implementing this guideline, and some of the key enablers were already in place. The identified enablers warrant future research to develop and evaluate effectiveness in improving outcomes.