Wednesday, 23 September 2009

Adoption of guidelines: trust?

A perennial issue on spread and adoption is how clinical guidelines are adopted - or not. There is an industry researching what happens, what might be useful intervention and what you can then do to increase the speed and amount of adoption.

My own rather accidental piece of "research" raised a new question for me: to what extent is trust both an enabler and disabler of the adoption process?

So I've been cooking. The real thing, with recipes. I spent the better part of a month working through many of the Women's Institute favourite 650 recipes. A trusted cookbook and mostly failsafe. What I found is it is incredibly difficult to follow a recipe down to all the details. The more I used recipes the more I found myself adapting them - to varying degrees of success.

Then I moved on to Nigella's Express cookbook. A week later I noticed I was slavishly adhering to every minute detail. Not like me at all. So what was going on here?

Nigella writes in the first person and the way recipes are written has engaged me in a new way. When a note in brackets suggests options, reassures you that she really did mean 250ml double cream or reinforces why this step is important, then it seems more trust in the process is repaid by more attention to detail in following instructions.

Many clinical guidelines are produced by committees. Yes they may be great sets of instructions, however, are they written as mechanisms that attract trust? I wonder what would happen if a trusted peer rewrite guidelines in a personal language and tone. Would they be adopted more quickly?

I did think maybe this is about personal choice of style of communication. Maybe. And should that detract from finding some novel ways to encourage the adoption of guidelines?


Chrissy Kistler said...

A number of guidelines are put together by committees with several drug companies' reps or people funded by drug companies, who have a vested interest in maligning the truth.

The hegemony of the hemoglobin A1C being a prime example.

With recent publication of how Forest pushed its drugs with CME, I can't help but worry about some of the guidelines coming out these days.

I think you have a very valid point that humans often need to know why they are asked to do something and if they don't they will often not perform as you (or the book maker) would like. Why should I wash my hands? (a little bracket detailing the number of people I'm likely to kill, etc, would be useful!) Why should I keep a surgical patient normothermic? (a little bracket detailing how many wound infections I might cause) And so on... Given all people tell us to do, understanding priorities such as: we can have some variation in how you do X and Y but NOT Z BECAUSE if Z isn't done correctly, some number of people will die, might be really helpful!

Great post!

Trine Petersen said...

Great post, and great comment