At this point you’ve not only planned your implementation initiative as discussed in our previous article, but you’ve also begun to actually implement it. A very critical (and often overlooked) step is to measure and evaluate your change, with a goal of optimization and iterative refinement and improvements. Also, to communicate your findings internally in the hopes of achieving long term buy in for future implementation campaigns. This post will explore these steps in more detail.

Step 6 of the guideline implementation process can be simplified to the following high level activities:

  • Collect and analyze data on a regular, ongoing basis as you implement your interventions.
  • Compare pre and post intervention data to understand how the interventions are changing behaviors, as well as outcomes. Also consider the financial implications of the increased adherence. Did costs decrease? Did reimbursement increase? Did time spent decrease?
  • Communicate your findings within your organization.
  • Implement a continuous improvement cycle to ensure the change(s) are not only permanent, but increasing over time.

Monitoring

For meaningful evaluations, conclusions, and actions, and to ensure a continuous cycle improvement, you need to ensure you are collecting the right data during the monitoring process. Benefits of ongoing monitoring of outcomes include:

  • Increased accountability among stakeholders
  • Opportunity to deliver quick wins for increased team and administrative buy in
  • Results are spotted more quickly, including identification of current strengths, weaknesses, opportunities, and threats to implementation wins
  • It informs future actions and improvements

Audits

The audit is an important part of Step 6. It is comprised of:

  • Monitoring and Measurement
    • This involves the routine collection of audit criteria, including key performance indicators (KPIs), over the course of the implementation/interventions. It makes use of existing data and information about inputs, outputs and outcomes, or about outside factors affecting the organization or project, to inform improvement.
  • Comparison
    • Look at data pre and post implementation to identify any changes over time. The changes may involve multiple layers, including: management decisions made, patient outcomes, finances, patient satisfaction scores, and more. 
  • Evaluation
    • The evaluation draws specific conclusions based on the data collected, including the comparison data. It assesses whether the implementation strategies are meeting expectations, and provides the basis for the next part of the audit… action.
  • Action
    • This is where you will identify specific step(s) to take based on the results of the evaluation. This may include changes to existing interventions, new implementation tools to support specific interventions, addition of new interventions, and more. 

Revisions & Improvements

A combination of the actions involved in your audits can be utilized to create a formal revision/improvement plan. Reflecting on emerging evidence on outcomes and implementation provides opportunities to learn from experience and inform future implementation. If guidelines are not being implemented as intended or are being used as intended but not producing desired outcomes, improvement cycles can be used to support continued improvement and change. This will have the benefit of enabling implementation teams to engage both themselves and leadership in using data to support implementation capacity, fidelity, and patient outcomes, and to ensure decisions are data-based, purposeful and planned, rather than opportunistic and reactionary.

That concludes Step 6, so now on to Step 7…

The good news is that Step 7 is really quite simple – rinse and repeat for each specific intervention, and for new guideline(s) implementation programs. Based on the data you collected and your key takeaways on what did/did not work as expected, begin to plan the next intervention(s) for the specific guideline, or even the next guideline implementation initiative. 

To Recap 7 Key Steps for Implementing Clinical Practice Guidelines At Your Organization

  1. Step 1 – Identify the guideline recommendation(s) that you wish to implement
  2. Step 2 – Measure current practice at your institution
  3. Step 3 – Identify potential barriers (and enablers) to implementing the recommendation
  4. Step 4 – Determine interventions to mitigate the identified barriers.
  5. Step 5 – Implement the strategies to improve adherence to the selected recommendation(s)
  6. Step 6 – Measure and evaluate change
  7. Step 7 – Repeat

We’ve compiled a list of guideline implementation studies and toolkits below to help you start the process of creating your own guidelines implementation plan. 

There you have it – the conclusion of our multi-part clinical guidelines implementation strategies series. Do you have suggestions or requests for what our next major series should be? Feel free to send us an email or reach out to us via social media and let us know!

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