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Clinical Practice Guidelines: Directions for a New Program (1990)

Chapter: 4 Implementation and Evaluation

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Suggested Citation:"4 Implementation and Evaluation ." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 78

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IMPLEMENTATION AND EVALUATION 78 4 Implementation and Evaluation The separation of policy design from implementation is fatal. Pressman and Wildavsky, Implementation The primary charge to the study committee was to advise AHCPR and the Forum about definitions and attributes of guidelines with an emphasis on the agency's near-term responsibilities. Therefore, the committee was quite selective in its attention to implementation and evaluation matters. The major proposition here is that implementation and evaluation strategies should reinforce the credibility, validity, clarity, and other attributes of good guidelines identified in Chapter 3. The committee's examination of implementation and evaluation issues began with six basic propositions. • First, guidelines are not self-implementing. • Second, the effectiveness of guidelines in reaching their intended objectives cannot be assumed but must be tested. • Third, attention to implementation and evaluation issues should be built into the processes of guidelines development rather than dealt with sequentially. • Fourth, many parties must contribute if guidelines are to be successfully implemented and evaluated. • Fifth, the eventual revision or redesign of guidelines and their

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