Enhancing the use of clinical guidelines: a social norms perspective.

The McDonnell Norms Group Advances in clinical investigation, data analysis, rapid dissemination, and rigorous evaluation of the findings led to the accumulation of medical " evidence. " This evidence now forms the basis of thousands of guidelines developed and promulgated by professional societies, safety and outcomes organizations, provider institutions , and regulators. With rare exception, these guidelines are inconsistently implemented or used. This article reviews the history of guideline development and use, assesses the current state of implementation , identifies obstacles to adoption, and suggests strategies to overcome these obstacles. The major finding is that the current approach to development, dissemination , and encouraged use of guidelines is inconsistent with knowledge of psychology. The major recommendations are that the approach to translation of evidence into practice be revised to address convenience; to respond to public and peer demand; to provide immediate feedback concerning performance; and to leverage existing incentives, transparencies, and accountabilities. Implementation of these recommendations is expected to augment safety and best practice in the health-care community.