Accelerating adoption of the guidance

Roland Valori

Consultant gastroenterologist

November 2011

The problem

• Even when there is clear, evidence-based guidance on how a

problem should be managed, there remains unacceptable variation

in care

• There may be resource or infrastructure constraints, but differences

in the rate and completeness of adoption account for most of the

observed variation

Adoption of change

Unconscious

Incompetence

Conscious

Incompetence

Unconscious

Competence

Conscious

Competence

‘Conscious Competence’ of accelerating

adoption of change

Recommended reading

• Effective Health Care; 1999:5(1)

• Berwick D, Disseminating Innovations in Health Care.

JAMA; 2003:1969-1975

• Grol R, Wensing M, Eccles M. Improving patient care. The

implementation of change in clinical practice. Elsevier.

Ladder of adoption

unaware established practice

Effective Health Care 1999;5(1)

persuasion support

Raising awareness

• Target audience

• Communication media/methods

Factors that influence the tipping point

• Perception of the guidance

• Characteristics of the adopters

• Contextual factors

Perception of the guidance

• Perceived benefit

• Compatibility with values, beliefs and needs

• Is it simple?

• Is it easy to test?

• Is it easy to observe others using it?

Laggards

Late majority

Early majority

Early adopters

Innovators

Uptake of

a change

in practice

Time

Characteristics of the adopters

100%

50%

0

Characteristics of the adopters

Laggards

Late majority

Early majority

Early adopters

Innovators

2.5% 13.5% 34% 34% 16%

mean -1SD -2SD +1SD

Time

support

Persuading and supporting

unaware established practice

persuasion

Contextual factors

• Enabling organisations

• Prevailing culture

• State of readiness

• External levers

From prescription to description

• Identify your target audience

• Make the guidance easy to adopt

– written materials, web-based information, etc

• Invest in early adopters

• Make the early adopters ‘visible’

• Trust and enable re-invention

• Audit and feedback

Planning communications

• Describe the change:

– introducing guidance on ‘Optimal management of GI symptoms during

and after cancer treatments’

• Identify all the stakeholders

• Determine level of engagement or commitment required from each

– awareness, understanding, engagement, involvement and leading

• Define what communication techniques to use for who and when

Optimal management of GI symptoms during

and after cancer treatments

Stakeholder Awareness Understanding Engagement Involvement Leading

Oncologist +

Gastroenterologist +

Surgeon +

Macmillan nurse +

Pharmacist +

Ward manager +

Medical director +

GPs +

Hospice MD +

General manager +

Optimal management of GI symptoms during

and after cancer treatments

Level of engagement

E-Mail

Noticeboards

Interactive staff meetings

Letters Memos

Newsletters

Telephone

Clinical team meetings

Staff letters

Training needs analysis

Project team meetings

Technology

Face to Face Formats

Paper

Awareness Understanding Engagement Involvement Leading

Lev

el o

f en

gag

emen

t

Training

One to Ones

Website

Electronic dashboard

Patient feedback

Timing

support

Conscious competence of accelerating

change – where are you on this timeline?

unaware established practice

persuasion

UI

CI

UC

CC

Recommended reading

• Effective Health Care; 1999:5(1)

• Berwick D, Disseminating Innovations in Health Care.

JAMA; 2003:1969-1975

• Grol R, Wensing M, Eccles M. Improving patient care. The

implementation of change in clinical practice. Elsevier.