Low back pain: barriers to effective clinical governance

Abstract

PurposeThe purpose of this article is to investigate acceptability, dissemination and use of a multidisciplinary audit toolkit to monitor evidence‐based care for acute low back pain and to identify barriers to implementation of the RCGP evidence‐based LBP guideline and associated audit process.Design/methodology/approachA survey was carried out of 707 clinical governance leads (CGLs) and 336 clinical audit leads in English/Welsh Health Authorities, NHS Trusts, Primary Care Groups and Primary Care Trusts. Subsequently, structured telephone interviews with 50 CGLs and 22 CALs in 72 Primary Care Trusts were qualitatively analysed.FindingsSubstantive barriers specific to implementation of the RCGP LBP guideline and associated audit toolkit could not be identified. Issues were raised pertaining to the wider healthcare system, which itself may restrain implementation of evidence‐based health care for LBP sufferers. Qualitative analysis revealed six categories responsible for poor clinical governance. Results suggest that LBP is not a priority area and that without National Service Framework status this is unlikely to change.Research limitations/implicationsResponse to the initial survey was only 37 per cent; thus results may not be representative of all relevant UK NHS organisations. It coincided with a particularly busy period of change and ongoing reform, making it difficult to reach relevant personnel. This problem was accentuated by frequent change of persons in the post of clinical governance lead. All of this may have impacted on the response rate. In addition, some organisations/individuals were reluctant to be identified for the purpose of this study.Originality/valueThis study identifies the practical difficulties of delivering the clinical governance agenda, particularly in non‐priority areas, as reported by those responsible for doing so.