title: Examining the implementation of NICE guidance: cross-sectional survey of the use of NICE interventional procedures guidance by NHS Trusts.
abstract: BACKGROUND
  In the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations. Little is known about how NHS organisations implement such guidance and best practice for doing so. This study was therefore designed to examine the dissemination, decision-making, and monitoring processes for NICE interventional procedures (IP) guidance and to investigate the barriers and enablers to the implementation of such guidance.
  
  
  METHODS
  A cross-sectional survey questionnaire was developed and distributed to individuals responsible for managing the processes around NICE guidance in all 181 acute NHS hospitals in England, Scotland, Wales and Northern Ireland. A review of acute NHS hospital policies for implementing NICE guidance was also undertaken using information available in the public domain and from organisations' websites.
  
  
  RESULTS
  The response rate to the survey was 75 % with 135 completed surveys received. Additionally, policies from 25 % of acute NHS hospitals were identified and analysed. NHS acute hospitals typically had detailed processes in place to implement NICE guidance, although organisations recognised barriers to implementation including organisational process barriers, clinical engagement and poor targeting with a large number of guidance issued. Examples of enablers to, and good practice for, implementation of guidance were found, most notably the value of shared learning experiences between NHS hospitals. Implications for NICE were also identified. These included making improvements to the layout of guidance, signposting on the website and making better use of their shared learning platform.
  
  
  CONCLUSIONS
  Most organisations have robust processes in place to deal with implementing guidance. However, resource limitations and the scope of guidance received by organisations create barriers relating to organisational processes, clinician engagement and financing of new procedures. Guidance implementation can be facilitated through encouragement of shared learning by organisations such as NICE and open knowledge transfer between organisations.
authors.affiliation: York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK. kvl2@york.ac.uk.
authors.forename: Karin
authors.initials: K
authors.lastname: Lowson
authors.affiliation: York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK. michelle.jenks@york.ac.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Jenks
authors.affiliation: York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK. alex.filby@york.ac.uk.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Filby
authors.affiliation: York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK. louise.carr@york.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Carr
authors.affiliation: National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK. Bruce.Campbell@nice.org.uk.
authors.forename: Bruce
authors.initials: B
authors.lastname: Campbell
authors.affiliation: National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK. John.Powell@nice.org.uk.
authors.forename: John
authors.initials: J
authors.lastname: Powell
mesh_terms: D000047:Academies and Institutes / Q000458:organization & administration* / Q000592:standards; D003142:Communication; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D033181:Information Dissemination; D007256:Information Systems; D007857:Leadership; D057766:Policy; D017410:Practice Guidelines as Topic; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D006113:United Kingdom