Thursday, 29 October 2009

Disseminating guidelines using MBTI Style

One of the eternal difficulties in the dissemination and application of clinical evidence is what I believe to be the " style gap".

Either they are researched and written so generically it is difficult for any individual or team to see how they apply to them. Or they are written so specifically that individuals and teams are so constrained to the detail and working out how they apply to themselves, they don't implement.
Different groups and organisations have developed their own ways round this problems. At a National or Regional level, boards and groups develop guidelines that are generic and then disseminate with a covering letter urging local adaptation of these guidelines. They know there will need to be local differences and contexts taken into account so they acknowledge this. This raises some questions for me:
  • to what extent does turning the generic into the specific mean the intended benefits remain?
  • are there different bits that can be adapted in different ways? Do the authors suggest how different bits can be adapted?
  • what are the systemic links with other pathways, clinical areas etc that need to be taken into account?
  • what are the contextual variables that are necessary for the generic guideline to be implemented (things like resources)?
  • Where to start? Something practical?
For those guidelines which are so specific as to be overwhelming
  • how do all these details scale up into themes and topics?
  • what are the patterns and links to systems that will be useful to know about?
  • which if the details are most important? Which ones can be left out and the main benefits are still reached?
  • is there a specific order to implementation?
  • how to the parts integrate with other systems like IT and HR?
I don't know the solution to this. What I do know is that many clinical and process guidelines are written in the MBTI (Myers Briggs Type Indicator) N/Intuitive style. This is the big picture, system and pattern way of seeing things. In contrast many of those required to implement these guidelines are more comfortable working with details (MBTI S/Sensing) and make sense easier of instructions if they are practical and specific. Sometimes the reverse is true - S's develop guidelines for N's to implement.

All the other parts of the MBTI styles could be a factor in the adoption of messages that change personal behaviour.

Perhaps one way round this is to use dissemination processes and content in a way which best suits the style of the potential adopters rather than the comfort of the authors.

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