title: Not of one mind: mental models of clinical practice guidelines in the Veterans Health Administration.
abstract: OBJECTIVE
  The purpose of this paper is to present differences in mental models of clinical practice guidelines (CPGs) among 15 Veterans Health Administration (VHA) facilities throughout the United States.
  
  
  METHODS
  Two hundred and forty-four employees from 15 different VHA facilities across four service networks around the country were invited to participate. Participants were selected from different levels throughout each service setting from primary care personnel to facility leadership.
  
  
  METHODS
  This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis.
  
  
  METHODS
  A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility.
  
  
  RESULTS
  Analysis of these interviews using grounded theory techniques indicated that there was wide variability in employees' mental models of CPGs. Findings also indicated that high-performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a tendency to use performance feedback as a learning opportunity, thus suggesting that a shared mental model is a necessary but not sufficient step toward successful guideline implementation.
  
  
  CONCLUSIONS
  We conclude that a clear shared mental model of guidelines, in combination with a learning orientation toward feedback are important components for successful guideline implementation and improved quality of care.
authors.affiliation: ALMD/South Texas Veterans Health Care System, 7400 Merton Minter Blvd. Ambulatory Care 11C6, San Antonio, TX 78229-4404, USA.
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.forename: Richard G
authors.initials: RG
authors.lastname: Best
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Pugh
authors.forename: Frank I
authors.initials: FI
authors.lastname: Moore
mesh_terms: D001291:Attitude of Health Personnel; D005246:Feedback; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008960:Models, Psychological; D015279:Organizational Culture; D017410:Practice Guidelines as Topic / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs