I was recently lucky enough to chair a committed, motivated and enthusiastic committee responsible for developing the NICE guideline on transition from children’s to adults’ services. During that period, I was able to observe first-hand how such information is produced, and a number of things occurred to me about how the right approach during development can lead to a good and useful guideline.
The most obvious sign that a guideline is successful, of course, is whether the recommendations are implemented. Before this can happen, people – and not just specialists and academics – need to understand what is being asked of them. The wording must be clear; the described actions unambiguous.
It’s so easy to get this wrong. And when we do, it’s mainly because we don’t think enough about our readership.
Who reads NICE guidelines?
NICE guidelines have a wider audience than one might think. Anyone interested in health, quality of care and value for money is potentially a consumer of NICE products. This includes people who use services and their carers. It increasingly includes not only people in senior clinical and managerial positions but practitioners from different disciplines, with different levels of skills, experience and knowledge – including those still in training.
NICE readership is global. I know from personal experience that colleagues across Europe, not just the Anglosphere, use NICE information too. Such wide readership makes it essential that NICE guidelines use language that is precise, concise and jargon free, to ensure the recommendations are unambiguous.
The dangers of confirmation bias
We all tend towards confirmation bias – that is, we search for, or interpret, information in a way that confirms our preconceptions. NICE is often trying to address complex issues that rarely have a simple answer. It seeks to ensure that we use limited resources wisely. In short, it doesn’t always tell us what we want to hear. If recommendations were too open to interpretation it would be all too easy to read into them what we wanted them to say.
So it’s important that guidelines undergo a rigorous editing process to ensure they say what they need to clearly for all the people who will use them.
How editors add value
It’s not always easy. From personal experience of chairing a guideline committee, I found that being immersed in the details sometimes made one unaware of obvious errors, inconsistencies and lack of clarity. Luckily, this is where editors come in. A fresh, objective and disinterested editor can offer helpful challenges, spot errors and ambiguity, remove redundancies and greatly improve clarity and consistency.
Overall, I was extremely impressed by the NICE process. No approach to producing guidance is perfect or without occasional irritations, but this is perhaps the best mechanism in the world for balancing safe, effective, evidence-based and high-quality care with best value for money.
Professor Swaran Singh is head of Mental Health and Wellbeing and deputy head of the division of Health Sciences at Warwick Medical School, at the University of Warwick. He is consultant psychiatrist at Birmingham and Solihull Mental Health Foundation Trust and Forward Thinking Birmingham. He is a commissioner of the UK Equality and Human Rights Commission.
He has published extensively on culture and ethnicity in mental health, onset and outcomes of early psychosis, early intervention services, transition from child to adult care, mental health law and medical education.