Table 1 |
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summarizes reported barriers and facilitators influencing implementation of clinical guidelines. |
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Categories and subcategories |
Barriers |
Facilitators |
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Organizational resources |
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Staff |
Lack of time |
Clear roles |
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No agreement on need to use clinical guidelines |
Included in decision-making processes |
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Emotional exhaustion |
Sufficient time |
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Influence of prior experiences |
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Workload |
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Information overload |
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Learning culture |
Lack of learning culture |
Promotes learning organization |
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Leadership |
A lack of dedicated time |
Strong leadership |
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Lack of investment from the organization |
Active department chief |
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Guidelines not mandatory |
Head of department supported the implementation |
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Lack of organizational strategy and skills |
Effective organizational structures |
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Resistance to multi-disciplinary team |
Empowering approach to learning |
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Concerns about resources |
Multi-disciplinary implementation team |
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Lack of financial resources |
Awareness of clinic attitudes and actions |
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Effective teamwork |
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Dissemination |
Lack of clear intervention goals |
Supporting implementation |
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No regular implementation meetings |
Planning the implementation process |
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Guideline format |
Access to guidelines tools and recommended clinical scales |
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Change clinical patterns |
No measurement or tools for evaluation of care |
Feedback on performance |
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Audit used routinely |
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Quality indicators |
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Measuring 'before' in order to identify gap |
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Facilitation |
Lack of facilitation |
External facilitation |
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Academic outreach visits |
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Driving local change |
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Health care professionals' individual characteristics |
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Attitudes and beliefs |
Negative attitudes to clinical guidelines and new action |
Positive attitudes and beliefs regarding guidelines and new action |
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Perceived limited validity of guidelines |
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Fear of loss of autonomy |
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Fear of standardization of care |
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Concerns about relevance of evidence to own patients |
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Lack of internalization of guidelines |
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Knowledge |
Lack of research skills |
Increased knowledge |
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Lack of specialized training |
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Perception of guidelines and implementation strategies |
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Credibility of content |
Change in recommendations |
Increased accountability |
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Overestimation of current care |
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Awareness |
Lack of familiarity with guidelines |
Practitioner's awareness |
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The first column represents categories and subcategories. Examples of factors influencing the implementation work as reported in the interviews (columns 2 and 3). |
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Forsner et al. BMC Psychiatry 2010 10:8 doi:10.1186/1471-244X-10-8 |
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