Professor Susan Michie, UK
Professor of Health Psychology, University College London , UK
 Professor Susan Michie, Professor of Health Psychology at the Centre for Outcomes Research and Effectiveness, University College London (UCL), has a background in clinical and health psychology.
Her current role at UCL involves research, consultancy and postgraduate teaching. She is also seconded part-time to the UK Department of Health to advise on behaviour change in relation to health, and to the Medical Research Council's Health Service Research Collaboration to lead a program of implementation research.
Professor Michie's research on implementing clinical practice guidelines highlights the importance of language and wording.
Here, she outlines why failing to understand how people behave can be a major obstacle to successfully implementing clinical guidelines recommendations.
Getting the message across: wording guidelines recommendations
If we want people want to do things differently at work, the challenge is to understand the links between the words in guidelines and the desired behaviour of the people who will implement them. It's a simple enough concept. If people are favourably disposed to a guideline and if they are absolutely clear about what needs to be changed, then they are more likely to actually change their behaviour. There are three processes that have to happen.
Motivation
People have to be motivated to read the guidelines, which can help overcome common barriers such as cynicism and negative attitudes. One strategy is for workplaces to create time through initiatives like journal clubs for busy health professionals to read and discuss the guidelines.
Comprehension
People have to understand the guidelines. Guideline recommendations best support behavioural change if they describe the situation as well as the desired behaviour in specific terms, for example by using active verbs and if-then plans. This increases comprehension (understanding what should be done), recall (remembering what should be done), and planning and enactment of behaviour1. An observational study from The Netherlands2, a study in relation to back pain guidelines in the USA 3, and a UK study 4 of guidelines for the management of schizophrenia support these assertions.
Measurement
The guidelines have to be put into practice – and their implementation has to be measured . Precisely specifying targeted behaviour not only serves to increase implementation, but also enables us to know whether the guideline has been implemented. This is crucial for audit, evaluation and implementation research. If we are to develop strategies to improve the implementation of guidelines, we need to be able to accurately assess the extent of implementation in different circumstances.
Link to Professor Michie's Symposium presentations
1 Michie, S and Johnston, M (2004) Changing clinical behaviour by making guidelines specific. British Medical Journal. 328, 343-345.
2 Grol et al (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ . 317-61.
3 Shekelle et al (2000). Health Services Research. 34, 1429-48.
4 Michie, S and Lester, K (2005) Words matter: increasing the implementation of clinical guidelines. Quality and Safety in Health Care 32, 589-598. |
