Developing and gaining acceptance for patient care protocols.

The purpose of developing protocols and guidelines is greater than reducing variation in practice. The process also creates new paradigms and changes the culture in which health care is delivered. The protocol itself is designed to be transient. The new environment and perceptions of how to improve health care in the future, along with new relationships and processes to accomplish this, are the real power of learning to develop and implement protocols and guidelines. Framing the process of protocol development, therefore, is more important than the resulting document. In developing protocols, attention to changing the thinking and practice of the front-line practitioners, establishing new relationships, and devising new methods of delivering and improving care is key. The process of developing protocols should include all practitioners. They should remain in control of patient care using new methods that allow: a) the monitoring of process and outcomes, b) identification of problems, and c) the evaluation and validation of the effectiveness of implemented change. Evidence from the literature of strategies for protocol development and implementation which are effective in creating change are reviewed, and an example of a known effective method which improves practice is given.