Clinicians adopting evidence based guidelines: A case study with thromboprophylaxis

Chapman, NH; Lazar, SP; Fry, M; Lassere, MN; Chong, BH

Clinicians adopting evidence based guidelines: A case study with thromboprophylaxis

Chapman, NH Lazar, SP Fry, M

Lassere, MN Chong, BH

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Publication Type:: Journal Article
Citation:: BMC Health Services Research, 2011, 11
Issue Date:: 2011-10-04

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Field	Value	Language
dc.contributor.author	Chapman, NH	en_US
dc.contributor.author	Lazar, SP	en_US
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096	en_US
dc.contributor.author	Lassere, MN	en_US
dc.contributor.author	Chong, BH	en_US
dc.date.available	2011-09-28	en_US
dc.date.issued	2011-10-04	en_US
dc.identifier.citation	BMC Health Services Research, 2011, 11	en_US
dc.identifier.uri	http://hdl.handle.net/10453/29491
dc.description.abstract	Background: Venous Thromboembolism (VTE) is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods. Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results: Analysis of interviews revealed that barriers to evidence based practice include i) the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii) the culture of practice where team practice is ta0ilored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions: Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints. © 2011 Chapman et al; licensee BioMed Central Ltd.	en_US
dc.relation.ispartof	BMC Health Services Research	en_US
dc.relation.isbasedon	10.1186/1472-6963-11-240	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Hospitalization	en_US
dc.subject.mesh	Hospital Mortality	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Attitude of Health Personnel	en_US
dc.subject.mesh	Evidence-Based Medicine	en_US
dc.subject.mesh	Medical Staff, Hospital	en_US
dc.subject.mesh	Organizational Culture	en_US
dc.subject.mesh	Physician's Practice Patterns	en_US
dc.subject.mesh	Guideline Adherence	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Evaluation Studies as Topic	en_US
dc.subject.mesh	Interviews as Topic	en_US
dc.subject.mesh	Practice Guidelines as Topic	en_US
dc.subject.mesh	Venous Thromboembolism	en_US
dc.subject.mesh	Practice Patterns, Physicians'	en_US
dc.title	Clinicians adopting evidence based guidelines: A case study with thromboprophylaxis	en_US
dc.type	Journal Article
utslib.citation.volume	11	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	0807 Library and Information Studies	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.publication-status	Published	en_US
pubs.volume	11	en_US

Abstract:

Background: Venous Thromboembolism (VTE) is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods. Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results: Analysis of interviews revealed that barriers to evidence based practice include i) the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii) the culture of practice where team practice is ta0ilored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions: Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints. © 2011 Chapman et al; licensee BioMed Central Ltd.

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http://hdl.handle.net/10453/29491