Use of Soft Systems Methodology for Implementing Clinical Practice Guidelines in a General Hospital

Abstract

Background: It is challenging to implement evidence-based care and update and improve health care policy. Adhering to evidence-based Clinical Practice Guidelines (CPGs) serves as a guide for making decisions based on the best evidence and making an attempt to improve the quality of patient care and outcomes. Despite the need for implementing CPGs in Iranian hospitals, the concept and implementation method of CPGs are not clear yet. This action research aims to propose the soft systems methodology (SSM) to facilitate the implementation of CPGs in a general hospital in Iran. Methods: We employed the SSM to conceptualize the situation for the implementation of CPGs. Semi-structured in-depth interviews and group discussions with different stakeholders were used to define the purposeful activity model. The SSM tools and techniques were used to identify the main areas of change and select necessary measures to facilitate the implementation of CPGs. Flexible qualitative methods for data collection and analysis were utilized throughout the study. Results: Applying SSM for implementing CPGs could generate knowledge by recognizing hyper-complexity in healthcare setting, adopting an attitude of inquiry, and fostering dynamic changes in diverse and numerous worldviews of professionals in the accommodation process. This knowledge can provide a model for the successful implementation of CPGs at a macro-system level and facilitate the persuasion process for its implementation at the mesosystem level. More importantly, adopting SSM can create iterative learning loops over time and, thus, help the clinical microsystems face future healthcare complexities. Conclusion: The application of systems thinking approaches, especially SSM is recommended for implementing CPGs and addressing complex issues in healthcare settings and other system levels.