Implementation of clinical guidelines for female urinary incontinence: a comparative analysis of organizational structures and service delivery.

Abstract

The aim of the study was to explore and compare the development of continence services in two contrasting trusts. The first was a community trust which had initiated a top-down purchaser-led continence service. The second was a combined acute and community trust which had introduced a bottom-up, organic continence service based on staff development. The research used a qualitative, interpretative design. Evidence-based guidelines for female urinary incontinence (FUI) were analysed and key organizational features elicited. These were used to frame and analyse 20 semi-structured interviews with a range of community-based professionals who provided a service to women suffering from urinary incontinence. The interviews identified practitioner knowledge and awareness of the evidence pertaining to the management and treatment of FUI and also the features of the organizational structure of service provision in their locality which facilitated or constrained the implementation of evidence-based treatment in this area. The findings suggest that evidence-based guidelines were more closely adhered to in practice, in the trust using organic approaches to service development. Top-down, purchaser led approaches were more prescriptive and circumscribed the scope of professional practice. This adversely affected access to services for women suffering from urinary incontinence. Organic approaches to service development produce more flexible, responsive services. It is difficult, however, to integrate this approach with strategic planning as the flexibility required maybe incompatible with managerial responsibilities for defining roles and organizational functions.