Implementation plan

Introduction

This plan has been drawn up with the aim of advancing the implementation of these guidelines. In order to compile this plan, an inventory of factors that could either facilitate or hinder the recommendations was carried out. The guideline working group has made recommendations concerning the timeline for implementation, the preconditions necessary for this and the actions that should be taken by various parties.

 

Methodology

In order to arrive at this plan, the working group has applied the following to each recommendation in the guidelines:

• the time point by which the recommendations should have been nationally implemented;
• the expected impact of implementation of the recommendation on healthcare costs;
• preconditions necessary to be able to implement the recommendation;
• possible barriers to the implementation of the recommendation;
• possible actions to advance the implementation of the recommendation;
• the party responsible for the actions to be undertaken.

 

Readers of this implementation plan should take the differences between ‘strong’ recommedations and ‘weak’ recommendations into account. In the former case, the working group clearly states what should or should not be done. In the latter case, the recommendation is less strong and the working group expresses a preference but leaves more room for alternatives. One reason for this could be that there is insufficient research evidence to support the recommendation. A weak recommendation can be recognised by its formulation and may begin with something like ‘Consider the…(Overweeg)’. The working group has considered the implementation of both weak and strong recommendations.

 

Implementation plan

Recommendation	Timeline for implementation: < 1 year, 1 to 3 years or > 3 years	Expected effects on costs	Preconditions for implementation (within specified timeframe)	Possible barriers for implementation1	Supposed actions for implementation2	Who is responsible for the action(s)3	Other comments

¹ Barriers can exist at the level of the professional, at the level of the organization (the hospital) or at the level of the system (outside the hospital). Consider, for example, disagreement with regard to the recommendation in different organizations, insufficient motivation or knowledge of the specialist, insufficient facilities or personnel, necessary concentration of care, costs, poor cooperation between disciplines, necessary rearrangement of tasks, et cetera.

² Actions that are necessary for implementation, but also actions that are possible to encourage implementation. Consider, for example, checking the recommendation during a quality review, publication of the guideline, developing implementation tools, informing hospital administrators, arranging proper reimbursement for a certain type of treatment, making cooperation agreements.

³ Who is responsibilities for implementation of the recommendations will also depend on the level of barriers. Barriers at the level of the professional will often have to be resolved by the professional association. Organizational barriers will often be the responsibility of hospital administrators. Other parties, such as the NZA and health insurers, are also important in resolving barriers at system level.

 

Actions to be undertaken by each party

Below is a list of actions that in the opinion of the guideline working group should be undertaken to facilitate the implementation of the guidelines.

 

All academic and professional organisations that are directly involved

• Tell members about the guidelines. Publicise the guidelines by writing about them in journals and disseminating news of them at congresses.
• Provide professional education and training to ensure that the expertise required to follow the guidelines is available.
• Where relevant and possible, develop resources, instruments and/or digital tools to facilitate the implementation of the guidelines.
• Monitor the way in which the recommendations are put into practice by means of audits and quality inspections.
• Include indicators developed for these guidelines in quality registrations and indicator sets.
• Make interprofessional agreements about implementing continuous modular maintenance of the guidelines.

 

Initiatives to be undertaken by the professional organisation

• Hospital management boards and other system stakeholders (where applicable), should be kept informed of recommedations that could have an effect on the organisation of care and on costs, and on what may be expected by the party concerned.
• Publicise the guidelines to other interested academic and professional bodies.

 

Local professional groups/ individual medical professionals

• Discuss the recommendations at meetings of professional groups and local working parties.
• Tailor local protocols to fit the recommendations from the guidelines.
• Follow the continuing professional education on these guidelines (yet to be developed).
• Modify local information for patients using the materials that the professional bodies will make available.
• Make agreements with other disciplines involved to ensure the implementation of the recommedations in practice.
• Register pre- and postoperative factors and, as far as is possible, include important considerations for decision-making in existing protocols and the electronic dossier.

 

The system stakeholders (including health insurers, NZA, hospital managers and their associations, IGZ)

Health insurers are expected to reimburse the costs of the care that is prescribed in the guideline. When the time frames for implementation have elapsed, health insurers can use the strong recommendations in these guidelines for purposes of purchasing care.

 

Researchers and subsidy providers

Initiate research into the knowledge gaps, preferably in a European setting.

 

Knowledge Institute Federation of Medical Specialists

Publicise these guidelines among the staff and contect to development of related guidelines.

Add guidelines to guideline database. Incorporate this implementation plan in a place where all parties will be able to find it.