A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines

Theories from social and behavioural science can make an important contribu tion to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual fra mework for guideline dissemination and implementation is presented which dr aws on relevant concepts from diffusion of innovation theory, the transtheo retical model of behaviour change, health education theory, social influenc e theory, and social ecology, as well as evidence from systematic literatur e reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for pre-implementation assessment of (a) read iness of clinicians to adopt guidelines into practice, (b) barriers to chan ge as experienced by clinicians, and (c) the level at which interventions s hould be targeted. It also incorporates the need for multifaceted intervent ions, identifies the type of barriers which will be addressed by each strat egy, and develops the concept of progression through stages of guideline ad option by clinicians, with the use of appropriately targeted support strate gies. The potential value of the model is that it may enable those involved in th e process of guideline dissemination and implementation to direct strategie s to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation re quires validation by further empirical research. Until such research is ava ilable, it provides a theoretical framework that may assist in the selectio n of appropriate guideline dissemination and implementation strategies.