Table 1 Guideline implementation planning checklist

Implementation should be considered at the beginning, and throughout the guideline development process

[26-29]

Form an implementation team from the start that includes stakeholders (patient groups, end users, champions, relevant organizations and agencies, policy-makers) and one or more knowledge translation experts

[26-28,30-33]

Identify and assemble resources for implementation

[27,34]

Audit current practice as a baseline needs assessment

[32]

Consider or assess barriers of guideline implementation and use (patient, professional, organizational, system, economic, political, social/cultural), and stakeholder needs and preferences through literature review, observation, focus groups, interviews or survey

[27,30-39]

Consider dissemination and/or implementation on a recommendation-by-recommendation basis rather than for entire guideline

[33]

Determine the dissemination and implementation strategies that are effective and best suited to address identified needs and barriers

[27,30-36,40]

Determine what implementation tools will be developed based on: guideline scope; guideline recommendations; identified knowledge gaps or baseline audit; interviews or focus groups with guideline users

[30,35,40,41]

Develop an implementation plan describing dissemination and implementation strategies and tools, roles and responsibilities, milestones, time frames, and implementation measures

[26-28,32,38,42]

Consider pilot testing the implementation strategy on a small scale and adjust as needed after the pilot test and on an ongoing basis

[32,34,38]

Continue to engage stakeholders with outreach and education throughout the guideline development process

[27,30-33,40]

Ensure guideline recommendations are implementable and can be integrated in computer decision support systems

[35,41]

Research potential designs for type(s) of tools selected

[30]

Identify resources that will be needed

[30]

Present draft tool to guideline development group

[30]

Refine the tool with feedback, and several iterations may be needed

[30]

Test tool usability with clinician or patient interviews or focus groups

[30]

Feedback is used to refine the tool

[30]

Final version is reviewed by the guideline development group

[30]

Implementation tools are published at the same time as the guideline

[26]

Potential implementation tools include:

Versions in different languages

[27,28,43]

Versions in different formats (mobile devices, pocket guide, wall poster)

[26,29-31,44-47]

Summary versions (short version, recommendations only, evidence only)

[26,28,29,32,35,37,38,42-44,46-51]

Patient or plain language version

[26,27,35,43,46,48,49]

Point-of-care tools (algorithms, checklists, decision aids)

[27,28,35,36,38,48-50,52]

Electronic medical record/computer decision support system integration

[30]

Implementation plan (recommended strategies, barriers specific to the guideline and its recommendations, instructions)

[28,36,43,48,53,54]

Teaching aids (slide set, case examples, meeting agenda)

[27,42,47,49,52,53]

Patient and caregiver resources

[28,32,35,36,45,48,50,52]

Resource planning guide (human, infrastructure, technological capacity needed to implement and apply the recommendations)

[36,48]

Costing tools (spreadsheet, report templates)

[26,53]

Evaluation plan (instructions, measures, data collection instruments)

[26-28,32,35,36,39,45,48,50,53]

Dissemination options include:

Web site (guideline, implementation tools, accredited CPD modules)

[26,27,29,32,35,38,43-49,51,55-58]

Journal publications (which can link to online material)

[26,27,29,30,35,37,42-49,51,55-57,59,60]

Press release

[31,35,47,49]

Mass media campaign

[27,30,32-34,41]

Email distribution

[35,44,49]

Podcast or webinar

[35,45]

Register with AHRQ Guideline Clearinghouse and G-I-N Library

[35]

Partnerships (national organizations, networks)

[26,31,45]

Endorsement by specialty society

[31,45]

Marketing strategies

[31]

Traditional arts

[31]

Implementation options include:

Printed educational material

[31-34,36,40,41]

Educational meetings (conferences, workshops, CPD)

[26,30-36,39-42,44,46,60]

Educational outreach/Academic detailing

[32-34,36,40,41,60]

Local opinion leaders

[32-34,36,40,41,60]

Audit and feedback

[32-34,36,40-42,60]

Reminders

[32,33,36,39-41,60]

Multi-faceted interventions

[32,36]

Patient-mediated interventions (educational material, decision support tools, mass media campaign, reminders)

[32-43,40]

Organizational interventions (revision of professional roles or teams, leadership engagement)

[33,34,40]

Financial incentives or penalties

[32,33,41]

Computer decision support systems

[33,41]

Regulatory interventions/accreditation

[33,41,42]