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Implementing clinical guidelines
  1. Josephine Mayer1,
  2. Christopher Kipps2,
  3. Hannah R Cock1
  1. 1 Institute of Medical and Biomedical Education, University of London Saint George’s, London, UK
  2. 2 Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Hannah R Cock, Institute of Medical & Biomedical Education, University of London Saint George's, London SW17 0RE, UK; hannahrc{at}


Clinical guidelines that support practice and improve care are essential in this era of evidence-based medicine. However, implementing this guidance often falls short in practice. Sharing knowledge and auditing practice are important, but not sufficient to implement change. This article brings together evidence from the study of behaviour, education and clinical practice and offers practical tips on how practising neurologists might bring about change in the healthcare environment. Common themes include the importance of team working, multidisciplinary engagement, taking time to identify who and what needs changing, and selecting the most appropriate tool(s) for the job. Engaging with the challenge is generally more rewarding than resisting and is important for the effective provision of care.

  • guidelines
  • implementation
  • change
  • service improvement
  • education

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  • Contributors HRC conceived of, initiated and outlined the original article. JM led the literature review, summarised the evidence and wrote the first draft. All authors contributed to editing and revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests HRC reports personal fees from Sage Pharmaceuticals Ltd, personal fees from Eisai Europe Ltd, personal fees from UCB Pharma Ltd, personal fees from European Medicines Agency, personal fees from UK Epilepsy Nurse Specialist Association, non-financial support from Special Products Ltd, grants from US NIH Institute of Neurological Disorders and Stroke, non-financial support from International League Against Epilepsy, Status Epilepticus Classification Task Force, non-financial support from International League Against Epilepsy, Epilepsy Certification (education) Task Force, non-financial support from European Academy of Neurology, outside the submitted work. CK receives support from the Wessex NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC).

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed by Paul Cooper, Manchester, UK.

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