Table 3 CPG implementation barriers: top five prioritized themes categorized by implementation strategy18 with NGT item examples
Barrier theme | Examples of NGT items |
|---|---|
1. Organizational factors | |
Develop stakeholder interrelationships | Conflict with institutional policies |
External and internal resource allocation: staff, space/geography, money and medication | |
Coordinating between peds/adult services for AYAs | |
Variability of institutions caring for same patient (inconsistency, HR, location, providers) | |
Convene teams | Lack of collaboration between disciplines within division |
Availability of personnel/resources/expertise related to CPG | |
Utilize financial strategies | Cost to implement change |
Access to specialists/meds to support CPG | |
Engage consumers | Lack of incentives to use CPGs |
Differences in “school of thought” and staff non-compliance with recommendations | |
Support practitioners | Time required electronic health record adaptation |
Change infrastructure | Nursing care delivery: Staffing, ratio, and location |
Lack of consistency | |
Continuity of process (external and internal) | |
Train and educate stakeholders | Lack of mandatory education for providers/staff in different departments |
New team members, staff turnover | |
Education of outside providers | |
2. Individual factors | |
Develop stakeholder interrelationships | Difference provider/team opinion and multiple providers in decision making |
Different practice styles/stubbornness/bad case (experience) | |
Belief by some providers that they already know | |
Health care professionals’ perceptions, experiences and standards of care | |
Ability to “network” with other institutions around best practices | |
Trust in CPGs | |
Convene teams | Lack of owner of CPG |
Utilize financial strategies | Insurance coverage/limitations/prior authorizations |
Formulary restrictions | |
Engage consumers | Language/cultural differences and preferences |
Adapt and tailor to context | Limitations of CPG for individual patient and lack of understanding regarding how to use CPG |
Train and educate stakeholders | Lag in education of professionals regarding CPGs or updates |
3. System factors | |
Develop stakeholder interrelationships | Administration hurdles/hospital bureaucracy |
Non-oncology staff providing care | |
Changing institutional culture is difficult | |
Convene teams | Time |
Provide interactive assistance | Technical/electronic health record challenges causing delays |
Support practitioners | High stress related to EHR |
Language/cultural differences and preferences | |
Change infrastructure | Speed of dissemination |
Lack of formal committee/procedure for CPG implementation | |
Adapt and tailor to context | No room for gray areas, conflicting guidelines |
Train and educate stakeholders | Time required for training |
4. User needs/values | |
Develop stakeholder interrelationships | Concern following some aspects of CPG |
Conflict with a local approach/study | |
Knowledge gaps between departments in same hospital | |
Convene teams | Not including other disciplines/team members in decision to follow/implement |
Engage consumers | Family/patient resistance and family stress |
5. Professional (education, training, or competencies needed by clinician/staff to deliver recommendations) | |
Provide interactive assistance | Time required for electronic health record adaptation |
Train and educate stakeholders | Keeping up with new literature |
Non-oncology staff providing care and educating other departments | |