Drowning in guidelines: how can we better translate evidence into practice and simultaneously build workforce capacity to improve healthcare safety and quality?

As a clinician, I understand that the clinical community seek solutions of “how” to resolve safety and quality concerns by turning to the research evidence. Yet, the research evidence remains vast and dynamic. Clinical practice guidelines, clinical care standards and the like are often comprehensive documents that critically analyse the abundance of evidence available, articulate professional consensus perspectives of ‘best practice’, and provide high-level implementation recommendations which may (or may not) incorporate policy and health system contextual features. Where this is done, I can say that this is no small feat, and for some topics even a miracle. However, it is not always understood the extent to which these resources can be used ‘in practice’ in the clinical practice setting.

Clinical practice guidelines for a single condition (e.g. heart failure) can be up to 100 pages long and with an executive summary which may be 15 pages in length. But what does a clinician do where there are multiple guidelines for the same conditions authored by different expert groups internationally? What happens if these guidelines conflict? Which ones can you trust and what fosters trust? Furthermore, with so many emerging diseases, technologies, medical advancements and discoveries, the time required to stay abreast of all this information can be extensive. This is particularly true for generalists such as general practices, allied health, and other primary care professionals.   

The challenge remains as to how to translate “the mountains of research evidence” into practical resources that are integrated into clinician workflow and offer real-time and tailored supports.

Enter HealthPathways. HealthPathways is currently active across 25 Primary Health Networks (PHNs) or local health districts in Australia, 8 health districts in New Zealand and 1 health district in the United Kingdom. It is an online tool that is designed to assist health care professionals, particularly GPs, deliver safe, evidence-based best-practice healthcare in the community through the collaborative development and adoption of localised clinical and referral pathways. HealthPathways is more than a clinical and referral resource that allows evidence to be applied in real time clinical practice and to assist primary care professionals to navigate the complex web of health services.

HealthPathways development is a process, one that offers many more benefits to our health system such as clinical leadership, networking and engagement. HealthPathways development prompts a systematic approach to local health community input, debate, review and critique the evidence. The pathway development process fosters clinical and specialist engagement around a shared issue and the chance for this broader health team to identify opportunities for health system improvement. Engagement occurs across the often ignored and unaddressed divide between the primary and hospital sectors[1]. There is also evidence to suggest that this process of collaboration has the opportunity to contribute to improvements in specialist clinic referral quality and appropriateness, specialist clinic demand and waiting lists, and increased management of low complexity or stable health conditions in the community1[2].

But, as any good quality improvement loyalist would admit, there is always still room for improvement. The outputs are published online, and future development are focused on maximising integration and adoption through the HealthPathways interface with other technological systems such as practice software programs, e-referral systems (i.e. those that facilitate the transmission of significant patient information from one treating healthcare provider to another), and the National Health Service Directory.  

Maximising research evidence use requires a multi-faceted approach. The solutions are technical, technological, and interpersonal/relational in nature. These must be used synergistically rather than in isolation. Clinician oriented strategies must focus on workforce capacity, system integration and fostering cross collaboration and engagement.

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About the author:

Roxanne Adams started her career in health as a physiotherapist, graduating from the University of Sydney in 2006 and working in hospitals and community health services in both Australia and the United Kingdom for the next 10 years. Roxanne recently completed a Master of Public Health and Master of Health Management with excellence at the UNSW and has been working at North Western Melbourne Primary Health Network in the HealthPathways team for the last year. Roxanne is currently leading a statewide project between the Victorian Primary Health Network Alliance and the Department of Health and Human Services in Victoria to support the implementation of Acute Specialist Clinic Reform.

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References:

[1] McGeoch, G., McGeoch, P., & Shand, B. (2015). Is HealthPathways effective? An online survey of hospital clinicians, general practitioners and practice nurses. NZ Med J128(1408), 2010-2019. Retrieved from https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1408/6413

[2] Gullery C (2014) as cited in McGeoch, G., Anderson, I., Gibson, J., Gullery, C., Kerr, D., & Shand, B. (2015). Consensus pathways: evidence into practice. NZ Med J128(1408), 86-96. Retrieved from https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1408/6418