Abstract
BackgroundIn the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations. Little is known about how NHS organisations implement such guidance and best practice for doing so. This study was therefore designed to examine the dissemination, decision-making, and monitoring processes for NICE interventional procedures (IP) guidance and to investigate the barriers and enablers to the implementation of such guidance.MethodsA cross-sectional survey questionnaire was developed and distributed to individuals responsible for managing the processes around NICE guidance in all 181 acute NHS hospitals in England, Scotland, Wales and Northern Ireland. A review of acute NHS hospital policies for implementing NICE guidance was also undertaken using information available in the public domain and from organisations’ websites.ResultsThe response rate to the survey was 75 % with 135 completed surveys received. Additionally, policies from 25 % of acute NHS hospitals were identified and analysed. NHS acute hospitals typically had detailed processes in place to implement NICE guidance, although organisations recognised barriers to implementation including organisational process barriers, clinical engagement and poor targeting with a large number of guidance issued. Examples of enablers to, and good practice for, implementation of guidance were found, most notably the value of shared learning experiences between NHS hospitals. Implications for NICE were also identified. These included making improvements to the layout of guidance, signposting on the website and making better use of their shared learning platform.ConclusionsMost organisations have robust processes in place to deal with implementing guidance. However, resource limitations and the scope of guidance received by organisations create barriers relating to organisational processes, clinician engagement and financing of new procedures. Guidance implementation can be facilitated through encouragement of shared learning by organisations such as NICE and open knowledge transfer between organisations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0283-4) contains supplementary material, which is available to authorized users.
Highlights
In the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations
NICE makes no recommendations about the implementation of interventional procedures (IP) guidance, but in England, the guidance is enforceable by the Care Quality Commission (CQC), and the NHS Litigation Authority takes adherence to IP guidance into account in risk assessing NHS hospital trusts [2]
Face validity was established through consultation with key informants familiar with the topic under investigation
Summary
In the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations. This study was designed to examine the dissemination, decision-making, and monitoring processes for NICE interventional procedures (IP) guidance and to investigate the barriers and enablers to the implementation of such guidance. Various organisations exist worldwide that produce evidence-based guidance and recommendations about health care. In the UK, the National Institute for Health and Care Excellence (NICE) provides evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation in practice. The NICE interventional procedures (IP) programme produces guidance “designed to protect patients’ safety and support people in the NHS in the process of introducing new procedures” [1]. NICE makes no recommendations about the implementation of IP guidance, but in England, the guidance is enforceable by the Care Quality Commission (CQC), and the NHS Litigation Authority takes adherence to IP guidance into account in risk assessing NHS hospital trusts [2]
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