Dr Mark Charny, Director, National Centre for Clinical Audit

Nowadays, there is an increasing emphasis on evidence-based practice. The data generated by research are often highly technical and difficult to read, and it may not be easy to see how, and to what extent, the findings apply to your individual patients. A methodology is developing for generating guidelines, which translates the evidence into practical recommendations in an easy-to-use format. These guidelines help to promote more effective practice.

Medendium's Guidelines already offers a handy reference manual, as do a range of other publications, including the Effective Health Care Bulletin published by the Centre for Reviews and Dissemination in York, and many others from professional organisations. Why then this new publication, why Guidelines in Practice?

Four of the more consistent findings about healthcare activity in developed countries, irrespective of their financing systems, are that:

  • there are very wide variations in every sort of clinical practice with every sort of patient
  • these variations are at best only partially explained by differences in disease patterns
  • no consistent association can be found between activity and outcome
  • clinical practice often does not conform to well-known and well-publicised recommendations (guidelines, standards, protocols).

These findings can only be understood by reference to the 'personal signatures' of clinicians, their individual styles of working. Clinicians are not robots following the detailed tracks of guidelines or protocols, but individuals whose behaviour is determined by a number of factors besides the information itself. These include:

  • a belief that change is necessary and possible
  • knowledge not only of what to do but how to go about changing local practice
  • the opportunity to make the necessary changes
  • the motivation to change
  • the opportunity to alter procedures, processes, personnel
  • the personal capacity to change one's own practice.

This list has little to do with clinical knowledge. There is little connection between being a good clinician and having a sophisticated understanding of systems and how to change them. Managers may not know much about clinical practice, but clinicians do not know enough about organisations and how they function.

We have paid more attention to producing guidelines than to making sure they effectively influence practice. The time has come to redress the balance. The new NHS has made clear the need to bridge the gap between theory and practice, evidence and care, knowledge and behaviour, information and performance. Guidelines in Practice is part of this trend. It is about applying guidelines, not about guidelines. The journal will:

  • help spread good practice
  • give tips on what went well, and on what did not work out
  • provide models to follow.

Of course, guidelines need to be adapted locally. There is a need for a sense of local ownership. Local circumstances, procedures, options, preferences and priorities will shape how a guideline is expressed. Local definitions have to be agreed. Every situation is different, but there are opportunities to learn from others, circumstances are often similar, even when they look quite different.

So, Guidelines in Practice is about what you do after you have the guideline. You can expect material from experts. But much more important is the experience of those who have tried something and are happy to pass their learning on. Guidelines in Practice will help you to put the knowledge to work.

Guidelines in Practice, October 1998, Volume 1
© 1998 MGP Ltd
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