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Doctors’ views of clinical practice guidelines: a qualitative exploration using innovation theory

Authors


  • This research was conducted while the authors were employed by the Health Services Utilization and Research Commission of Saskatchewan (HSURC). Positions listed were as at the time of the research.

  • In 2003, the Government of Saskatchewan dissolved the HSURC. By legislative authority, the HSURC’s legal successor organization and custodian of its archives is the Saskatchewan Health Research Foundation, ♯253 - 111 Research Drive, Saskatoon, Saskatchewan S7N 3R2, Canada.

  • Current positions and addresses of the authors: Joanne Hader, Senior Consultant, Performance and Contracts Management Waterloo Wellington Local Health Integration Network, Guelph, ON, Canada. Robin White, University College Professor, Psychology Department, University College of the Fraser Valley, Abbotsford, BC, Canada. Steven Lewis, Access Consulting Ltd., Saskatoon, SK, Canada; Adjunct Professor, Centre for Health and Policy Studies, University of Calgary. Jeanette L. B. Foreman, Northwest Research and Evaluation Coordinator, Research and Evaluation Department, Northern Health, Smithers, BC, Canada. Paul W. McDonald, Associate Professor, Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada. Laurence G. Thompson, President, Laurence Thompson Strategic Consulting and Adjunct Professor, Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

  • The views of the authors do not necessarily reflect the positions of HSURC, the Saskatchewan Health Research Foundation, or of the Government of Saskatchewan, or represent official policy of the Government of Saskatchewan.

Laurence G. Thompson
102–116 Research Drive
Saskatoon
SK
Canada S7N 3R3
E-mail: thompson@ltsc.ca

Abstract

Rationale, aims and objectives  The authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm’s-length government agency in a Canadian province. Using Orlandi and colleagues’ version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors’ views on implementation of clinical practice guidelines.

Methods  In semi-structured interviews with 45 representative doctors, the authors elicited doctors’ framework of meaning for behaviour change in general and for clinical practice guideline uptake in particular. These were then compared with the adapted Orlandi/Rogers diffusion of innovation model to confirm, amend or challenge that model.

Results  Doctors identified the following influences on changes to their clinical practice and on clinical practice guideline uptake, within a five-step innovation model:

1 innovation: evidence change is required, perceived need for change;

2 communication: awareness of innovation;

3 adoption: evidence of improved outcomes without increased patient risk, opinion leader support, consistency with current trends;

4 implementation: patient and family acceptability; and

5 maintenance: system support, patient and family support, observed improved patient outcomes without increased risk

Conclusions  Innovation for doctors is a complex decision process rather than a single decision point. Change occurs in the context of professional networks and patient and family support and demand.

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