Elise Talsma1, Rogier de Jonge2, Florian Cassel3, Moniek van de Loo4, Karen de Bijl-Marcus5, Estelle Mulder6, Hendrik Niemarkt7, Sandra Prins4, Mayke van der Putten8, Margriet van Stuijvenberg9, Remco Visser10, Anke Oerlemans11, Marije Hogeveen12. 1. Division of Neonatology, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands. 2. Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. 3. Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. 4. Amsterdam University Medical Centers, Amsterdam, The Netherlands. 5. University Medical Center Utrecht, Utrecht, The Netherlands. 6. Isala Women and Children's Hospital, Zwolle, The Netherlands. 7. Maxima Medical Centre, Veldhoven, The Netherlands. 8. Maastricht UMC+, Maastricht, The Netherlands. 9. Beatrix Children's Hospital University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 10. Leiden University Medical Center, Leiden, The Netherlands. 11. IQ healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands. 12. Division of Neonatology, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands. Correspondence to: Dr Marije Hogeveen, Amalia Children's Hospital, Radboudumc, Geert Grooteplein Zuid 6525 GA Nijmegen, The Netherlands. marije.hogeveen@radboudumc.nl.
Abstract
BACKGROUND: A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensus-based guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent. OBJECTIVE: This study investigated to what extent the guidelines were implemented and which factors played a role in implementation. STUDY DESIGN: A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semi-structured interviews, perceived barriers and facilitators for implementation were explored. PARTICIPANTS: Fellows and neonatologists working at all ten Dutch level 3-4 NICUs were eligible. RESULTS: On an average, NICUs implemented 12.6 (of 19) guidelines (range 6-17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation). CONCLUSION: The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.
BACKGROUND: A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensus-based guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent. OBJECTIVE: This study investigated to what extent the guidelines were implemented and which factors played a role in implementation. STUDY DESIGN: A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semi-structured interviews, perceived barriers and facilitators for implementation were explored. PARTICIPANTS: Fellows and neonatologists working at all ten Dutch level 3-4 NICUs were eligible. RESULTS: On an average, NICUs implemented 12.6 (of 19) guidelines (range 6-17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation). CONCLUSION: The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.
Authors: Tracy L Finch; Melissa Girling; Carl R May; Frances S Mair; Elizabeth Murray; Shaun Treweek; Elaine McColl; Ian Nicholas Steen; Clare Cook; Christopher R Vernazza; Nicola Mackintosh; Samridh Sharma; Gaery Barbery; Jimmy Steele; Tim Rapley Journal: BMC Med Res Methodol Date: 2018-11-15 Impact factor: 4.615
Authors: Carl R May; Frances Mair; Tracy Finch; Anne MacFarlane; Christopher Dowrick; Shaun Treweek; Tim Rapley; Luciana Ballini; Bie Nio Ong; Anne Rogers; Elizabeth Murray; Glyn Elwyn; France Légaré; Jane Gunn; Victor M Montori Journal: Implement Sci Date: 2009-05-21 Impact factor: 7.327
Authors: Greg Ogrinc; Louise Davies; Daisy Goodman; Paul Batalden; Frank Davidoff; David Stevens Journal: BMJ Qual Saf Date: 2015-09-14 Impact factor: 7.035