Intended for healthcare professionals

Education And Debate Clinical guidelines

Using clinical guidelines

BMJ 1999; 318 doi: (Published 13 March 1999) Cite this as: BMJ 1999;318:728
  1. Gene Feder (, senior lecturera,
  2. Martin Eccles, professor of clinical effectivenessc,
  3. Richard Grol, directorb,
  4. Chris Griffiths, senior lecturera,
  5. Jeremy Grimshaw, professor of public healthd
  1. a Department of General Practice and Primary Care, St Bartholomew's and the Royal London Medical College, Queen Mary and Westfield College, London E1 4NS,
  2. b Center for Quality of Care Research, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands,
  3. c Centre For Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA,
  4. d Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD
  1. Correspondence to: Dr Feder

    This is the last in a series of four articles on issues in the development and use of clinical guidelines

    In this series we have discussed the advantages and disadvantages of clinical guidelines, methods of guideline development, and the legal, political, and emotional aspects of guidelines. Assuming that the overriding purpose of clinical guidelines is to improve the quality of care for patients, in this final article we discuss how healthcare organisations (hospitals, general practices, etc) and individual clinicians can use clinical guidelines to improve clinical effectiveness.

    The development of good guidelines does not ensure their use in practice. Systematic reviews of strategies for changing professional behaviour show that relatively passive methods of disseminating and implementing guidelines—by publication in professional journals or mailing to targeted healthcare professionals—rarely lead to changes in professional behaviour. 1 2 Lomas observed that the failure of passive dissemination strategies is unsurprising given that many factors influence healthcare professionals‘ behaviour,3 and this has led to increased recognition of factors that help or hinder implementation at various levels: the organisation, peer group, and individual clinician. Therefore, to maximise the likelihood of a clinical guideline being used we need coherent dissemination and implementation strategies to capitalise on known positive factors and to deal with obstacles to implementation that have already been identified.

    Summary points

    The implementation of clinical guidelines within a clinical governance setting requires time, enthusiasm, and resources

    Local groups should adopt pre-existing valid guidelines

    Implementation activity should draw on the available evidence

    Clinical guidelines can also be used within continuing medical education or to answer specific clinical questions

    Using clinical guidelines within healthcare organisations

    In the same way as topics for guideline development need to be prioritised,4 organisations need a process by which they can set and pursue their clinical priorities. These can reflect national priorities or can be set at a …

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