Doctors' views of clinical practice guidelines: a qualitative exploration using innovation theory

Rationale, aims and objectives The authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm's-length government agency in a Canadian province. Using Orlandi and colleagues' version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors' views on implementation of clinical practice guidelines. Methods In semi-structured interviews with 45 representative doctors, the authors elicited doctors' framework of meaning for behaviour change in general and for clinical practice guideline uptake in particular. These were then compared with the adapted Orlandi/Rogers diffusion of innovation model to confirm, amend or challenge that model. Results Doctors identified the following influences on changes to their clinical practice and on clinical practice guideline uptake, within a five-step innovation model: 1 innovation: evidence change is required, perceived need for change; 2 communication: awareness of innovation; 3 adoption: evidence of improved outcomes without increased patient risk, opinion leader support, consistency with current trends; 4 implementation: patient and family acceptability; and 5 maintenance: system support, patient and family support, observed improved patient outcomes without increased risk Conclusions Innovation for doctors is a complex decision process rather than a single decision point. Change occurs in the context of professional networks and patient and family support and demand.