Open Access Highly Accessed Open Badges Research article

The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis

Rob Dijkstra1*, Michel Wensing1, Ruth Thomas2, Reinier Akkermans1, Joze Braspenning1, Jeremy Grimshaw3 and Richard Grol1

Author Affiliations

1 Centre for Quality of Care Research-117, Radboud University, PO Box 9101, 6500 HB Nijmegen, The Netherlands

2 Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK

3 Ottawa Health Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

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BMC Health Services Research 2006, 6:53  doi:10.1186/1472-6963-6-53

Published: 28 April 2006



To measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care.


Systematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies.


53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23).


Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.