Not of one mind: Mental models of clinical practice guidelines in the veterans health administration

Sylvia J. Hysong, Richard G. Best, Jacqueline A Pugh, Frank I. Moore

Research output: Contribution to journalArticle

32 Citations (Scopus)

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. Data Sources. 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. Study Design. This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis. Data Collection. A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility. Findings. 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.

Original languageEnglish (US)
Pages (from-to)829-847
Number of pages19
JournalHealth Services Research
Volume40
Issue number3
DOIs
StatePublished - Jun 2005

Fingerprint

Veterans Health
United States Department of Veterans Affairs
Practice Guidelines
Guidelines
Health Facilities
Interviews
health
Learning
grounded theory
Quality of Health Care
Information Storage and Retrieval
interview
employee
Primary Health Care
learning
personnel
leadership
present
performance
Grounded Theory

Keywords

  • Clinical practice guidelines
  • Feedback
  • Learning orientation
  • Performance
  • Shared mental models

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Not of one mind : Mental models of clinical practice guidelines in the veterans health administration. / Hysong, Sylvia J.; Best, Richard G.; Pugh, Jacqueline A; Moore, Frank I.

In: Health Services Research, Vol. 40, No. 3, 06.2005, p. 829-847.

Research output: Contribution to journalArticle

Hysong, Sylvia J. ; Best, Richard G. ; Pugh, Jacqueline A ; Moore, Frank I. / Not of one mind : Mental models of clinical practice guidelines in the veterans health administration. In: Health Services Research. 2005 ; Vol. 40, No. 3. pp. 829-847.
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