Hospital leadership and evidence-based guidelines

What role should hospital senior leadership play in implementing evidence-based guidelines? The recent paper by Patty Merola and Rodger Hopkins digs into this question:

What happens when senior leadership is not involved?

A more narrow departmental focus often results in a guideline implementation that does not achieve its full potential. For example:

  • Guidelines are used only by a very small cohort of staff: mostly case management (CM) or utilization management (UM) staff, discharge planners, and appeals staff. Because these types of staff typically interface with payors, guidelines become perceived as a necessary tool to assist with reimbursement rather than a decision-support tool that is part of a larger clinical/quality initiative.
  • Guideline selection is driven by what payors and auditors require versus what the most rigorous review of medical evidence has shown is necessary to deliver higher quality and efficiency. Or, alternatively, guideline selection is driven by input from end users who frequently focus on ease and efficiency of use at the risk of ignoring the more important scientific, evidence-based components. 
  • Physicians and some departments do not engage with the guidelines or may not even know they exist as a resource in the facility.
  • Guidelines are not used for decision-support by clinicians, so the impact on the quality and efficiency of care is limited or nonexistent.

Clearly, these scenarios strip guidelines of the potential to drive maximum quality and efficiency improvements.

Read the full paper here. To better understand the opportunity posed by evidence-based medicine, read “The convergence of healthcare quality and efficiency.”

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