Process and methods

15 Implementation support for good practice guidance

The aim of NICE implementation support is to encourage and promote the uptake of NICE guidance. Priorities identified by the Guidance Development Group (GDG), recommendations identified as having significant resource implications or resulting in a change in practice, and information from stakeholder consultation inform the focus of the implementation support work for good practice guidance (GPG). Support work may include a range of activities to promote uptake and the provision of practical support tools.

Implementation tools are produced by staff in the implementation programme at NICE. The following leads may be involved in developing the tools: the audit lead, the costing and commissioning lead, and the implementation adviser as appropriate to the GPG. Tools are developed with:

  • the GDG

  • the NICE project team

  • the lead from the Public Involvement Programme.

This section outlines the methods and process for developing the implementation tools, and the contributions of the GDG and NICE project support team to this process.

15.1 Needs assessment, support plan and tools

Each GPG is accompanied by an implementation needs assessment, which identifies significant changes to practice, any barriers to implementation and levers to support implementation.

For each GPG, the implementation adviser analyses the information gathered from the GDG, stakeholders and other sources to carry out a needs assessment, and produces an implementation support plan that details the activities that will be undertaken by NICE to address the key implementation issues. During the needs assessment, the implementation adviser consults with members of the GDG and the NICE project team.

15.1.1 Tailored implementation tools based on the needs assessment

The needs assessment may identify additional tools that would be useful for addressing specific learning or education needs of staff and organisations. These targeted tools for GPG are prepared by the implementation adviser with input from the NICE project team. There is some evidence that barriers to uptake of GPG identified in advance can be overcome by designing specific interventions to address them, although it is not always very clear how best to identify the barriers and which particular types of interventions are best for each barrier (Baker et al. 2010).

When there is an agreed need for specific implementation tools to support recommendations about drugs and prescribing, the implementation adviser works with the NICE Medicines and Prescribing Centre to produce these materials.

See Into Practice on the NICE website for examples of the types of tailored tools that are produced. These could include:

  • learning and development slide sets

  • clinical case scenarios

  • podcasts

  • training plans

  • online educational tools

  • examples of how NICE guidance has been put into practice

  • shared decision aids.

There might also be signposting to resources developed and promoted with other organisations, such as professional or patient groups. Identifying other organisations that may produce support tools to support implementation of the GPG is also encouraged.

Other tools that could be used are described below; not all guidance will have the same tools and these will be tailored according to the needs assessment. For more information, see the NICE website.

15.1.2 Baseline assessment tool

The baseline assessment tool is prepared by the audit coordinator. It is an Excel spreadsheet that organisations can use to identify whether they are in line with practice recommended in the GPG, and to help them plan activity to implement the recommendations.

15.1.3 Audit tools

Audit tools are prepared by an audit specialist. They help organisations to carry out audits based on some of the GPG's measurable recommendations. They consist of audit standards, data collection tools and action plans. Some will also be produced as Excel electronic audit tools that provide a basic data analysis and audit report.

15.1.4 Costing tools

Costing tools are prepared by a costing analyst. They are intended to help organisations assess the costs and potential savings associated with implementing the guidance. The costing analyst assesses the recommendations to identify those with the greatest resource impact (using NICE's Assessing cost impact – methods guide). NICE provides costing tools to accompany guidance that includes:

  • A costing report, which summarises the estimated national costs and savings associated with implementing the guidance and discusses the assumptions made in reaching this figure.

  • A costing template, which allows users to estimate the local impact of implementing the guidance based on their population and to change the assumptions and variables to reflect local circumstances.

  • A costing statement, which can be used when the cost impact is considered to be minimal to explain why the cost impact is not considered to be significant.

Further details of costing tools can be found on the NICE website.

15.2 Developing the implementation tools

The needs assessment and development of the implementation tools usually start during consultation and continue through to publication of the GPG.

15.2.1 Initial involvement during guidance development

At the start of the guidance development process, an implementation team is assigned to work with the NICE project team and GDG. The team consists of a costing lead, an audit lead and an implementation adviser, working closely with communications.

During scoping of the GPG, the implementation adviser carries out an initial assessment to ensure that all critical stakeholders have registered and starts to record a log of any implementation issues that arise. This log is kept up to date throughout guidance development to inform the development of the implementation support plan.

At GDG meeting 2 or 3, GDG members are given a general briefing paper from the implementation team explaining its work and future involvement.

At the end of GPG consultation, the costing analyst and the implementation adviser usually attend a GDG meeting to hear the outcome of the consultation and to consider how this affects key implementation issues. They can attend a GDG meeting to discuss their work.

The GDG may also invite other members of the implementation team to meetings at any time if discussion about other implementation issues is needed.

Volunteers from the GDG are needed to work with the implementation teams. Two members are needed to contribute to the development of the costing tools if these tool are needed (the 'GDG costing nominees') and 2 for the development of the implementation support tools (the 'GDG implementation support nominees'). After consultation, the implementation adviser liaises with the GDG implementation support nominees to discuss the implementation support plan and to agree their level of input into tool development.

15.2.2 Commenting on the draft implementation tools

Comments are invited on accuracy, clarity and whether the tools described below provide an accurate interpretation of the key messages of the GPG. Costing tools

The costing analyst uses the recommendations in the consultation draft of the GPG to identify the potential significant changes in resource use that are likely to arise from implementation of the GPG. This is based on baseline practice, how practice might change and the effect on resources for the areas identified. This is assisted by input from the GDG.

The costing analyst updates the draft costing tools when the final draft of the GPG is submitted. The tools are sent to the NICE project team and the GDG costing nominees 4–5 weeks before publication of the GPG for a 2‑week consultation period. Comments are invited on:

  • whether the assumptions made are reasonable

  • the usability of the costing template at a local level.

The NICE project team and the GDG nominees send their comments back to the costing analyst. Clinical audit tools

The audit coordinator sends drafts of the audit support tools to the NICE project team and the GDG for a 2‑week consultation period, approximately 9 weeks before publication of the GPG. Other tailored tools

Other draft implementation tools are usually sent to the NICE project team and the GDG for comment around 4–5 weeks before publication of the GPG for a 1‑week or 2‑week consultation period, depending on the nature of the tool. Advance notice is given of all timelines. Any delays to the development of the final GPG may reduce these periods.

15.3 Publishing the implementation tools

When implementation tools are published at the same time as the GPG by NICE, they are downloaded more frequently than if they are published later. Therefore the aim is to publish the implementation tools at the same time as the GPG wherever possible.

Achieving this is dependent on the final signed‑off version of the GPG being available with sufficient lead time for development of and consultation on the tools. For some support tools, a later timeline after publication of the GPG may be necessary.

Publication of the tools is announced on the NICE website and in the e‑newsletter; the latter is available to everyone who wants to be kept up to date with important developments at NICE.

15.4 Post-publication support

NICE may also carry out activities to help users implement good practice guidance after it has been published. These activities are identified in the implementation support plan (see section 15.1) and may include:

  • speaking at, and encouraging and supporting GDG members to speak at, relevant conferences and events

  • encouraging and supporting GDG members to contribute to or write journal articles about the GPG

  • contributing to or writing journal articles about the GPG

  • speaking about the implementation tools at events

  • supporting workshops and regional events

  • working with the implementation consultants (see section 15.6)

  • providing feedback and encouraging submission of shared learning (see section 15.6)

  • supporting the development of an online educational tool and other educational initiatives

  • supporting work to review uptake of the GPG.

15.5 Working with national organisations

The implementation adviser works in partnership with other NICE teams to engage with national organisations and networks. This work might include embedding recommendations from NICE good practice guidance into other guidance or initiatives, or encouraging the development of patient information.

The implementation advisers welcome suggestions from GDG members on how to work with national organisations to support the implementation of good practice guidance.

15.6 Other NICE implementation services and products

NICE also provides a range of services and products to assist health and social care professionals and organisations in the implementation of its good practice guidance recommendations. The following support is available:

  • NICE Medicines and Prescribing Associates work within their own NHS organisation, health board or service and in their wider local health economy to support high quality, cost effective prescribing and medicines optimisation. To help disseminate good practice as widely as possible, the NICE Medicines and Prescribing Associates are responsible for identifying affiliates within their local health economy to form local networks, or support existing networks where they are established. They also develop links with NICE Implementation Consultants and NICE Fellows and Scholars, to support further the sharing and dissemination of good practice.

  • A field-based team of 7 implementation consultants work with organisations to help to put NICE guidance into practice. Each consultant visits NHS, local authority and other organisations in their area, ensuring regular interaction with NICE stakeholders.

  • Web-based examples of how organisations have implemented NICE guidance are provided on the shared learning database.

  • NICE reports and published articles relating to the uptake of NICE guidance are provided on the 'uptake database' – ERNIE (Evaluation and review of NICE implementation evidence).

  • Commissioning guides are provided to support commissioners of services. These aid in the local implementation of NICE guidance through commissioning. Because the guides are focused on services commissioned, they may bring together elements from 1 or more pieces of NICE guidance. Each commissioning guide:

    • signposts and provides topic-specific information on key clinical and service-related issues to be considered during the commissioning process

    • offers an indicative benchmark of activity to help commissioners determine the level of service needed locally

    • includes an interactive tool that provides data for local comparison against the benchmark, and resources to estimate and inform the cost of commissioning intentions.

15.7 Further reading

Baker R, Camosso-Stefinovic J, Gillies C et al. (2010) Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2010, issue 3