Guideline adherence: How do boards of directors deal with it? A survey in Dutch hospitals

Abstract

Objective: Adherence to guidelines is often low, as multiple barriers exist for guideline implementation. To tackle the implementation problem, awareness of the existence of guidelines is necessary for the health care process and setting as a whole.
Purpose: Despite the importance of guidelines adherence, problems have been reported from hospitals in achieving this. This study gives insight into how boards of directors of general and specialist hospitals arrange the responsibilities for guideline adherence within their organisation, how they deal with guidelines for medical specialists and what opportunities exist for improvement.
Methods: A survey was sent to 116 Dutch hospitals in 2015. Thirty-nine responses were included in the study for further analysis (net response rate of 36%). All data other than the open questions were analysed in SPSS using descriptives to answer the research question.
Results: The findings demonstrated that the distribution of responsibility concerning guideline implementation is problematic. The boards of directors used a variety of information sources to keep informed about the status of implementation of the guidelines for medical specialists, mostly through medical specialists’ peer reviews (visits) and internal audits. The study revealed several opportunities for improvements, for example, that a national database is necessary with all up-to-date guidelines, whereby changes and news are distributed directly to hospitals and other stakeholders.
Conclusions: This paper offers recommendations for a thoughtful shift in distribution of responsibility, as in a more desired situation the ultimate responsibility of the board of directors would decrease and the responsibility of the medical specialists would increase.