12 Resources to support putting the guideline into practice

12.1 Introduction

Guideline committees consider implementation issues as an integral part of developing a guideline, and take account of comments on the draft guideline. NICE teams work with committees to consider what can be done to address implementation challenges, for example, by producing tools to help people put the guideline into practice, in line with our implementation strategy.

12.2 Tools for planning and resource impact assessment

NICE provides a baseline assessment tool for each guideline at the time of publication. This is a modifiable Excel spread sheet that organisations can use to identify whether they are in line with practice recommended by NICE, and to help them plan and record activity to implement the guideline recommendations.

NICE resource impact assessment tools are intended to help organisations assess the potential costs and savings associated with implementing the guideline. A resource impact report and an associated resource impact template are produced for guidelines that will have a substantial resource impact. The template enables a local estimate to be made of the potential costs and savings involved in implementation. If the resource impact is deemed not to be substantial, a 1‑page resource impact statement is produced.

12.3 Tools to support decision-making by practitioners and people using services

Visual summaries and quick guides

For some guidelines, there is a need for a visual summary of part of the guideline for health or care practitioners. For example, where practice needs to change, a practitioner needs to make quick decisions, or a specific audience needs support in implementing the recommendations.

Discussions about any visual summary or quick guide should happen as soon as possible. If NICE and the developer agree that a tool of this type will be helpful, the NICE editor will work with the developer to develop it for publication alongside the guideline.

For some topics, a quick guide is produced to help practitioners with putting recommendations into practice (for example, in a care home), or to support people using services to understand what to expect, and make decisions about their care.

Decision aids

If the committee identifies a preference-sensitive decision point in the guideline (see section 9.3), NICE may develop a decision aid.

Decision aids supplement or support the discussion between the person and their health or care practitioner about a preference-sensitive decision point, rather than replacing it. The person facing the decision can also refer to the aid after their appointment, and discuss it with their family and carers if they wish. NICE decision aids are written in non-technical language and include information about:

  • the treatment or care options recommended in NICE guidance

  • the aims of treatment or care and how likely the person is to benefit

  • possible adverse effects from the treatment or care options and the likelihood of experiencing them

  • other issues likely to be important to the person facing the decision (such as additional monitoring requirements and duration of treatment).

Decision aids usually include a visual representation of the likelihood of benefits or harms. They may also include a table to support the person to think about the relative importance to them of different factors in their decision.

If the committee identifies an area where there is a particular need for support with decision-making, the developer should alert NICE staff with responsibility for quality assurance during guideline development. NICE will decide whether to produce a decision aid. This is based on factors such as:

  • the value of a visual representation of the chance of benefits or harms

  • the complexity of the issues or the number of options the person is choosing between

  • whether or not the decision is 'high stakes' with possible life-changing consequences

  • whether or not the risks and benefits between options are similar, so that preferences will be the determining factor.

Each decision aid is developed by a project group with expertise in the topic area, including practitioners and people who use health and care services.

12.4 Working with other organisations and endorsing resources

Organisations and individuals, both lay and practitioner, can play a key role in supporting the implementation of the guideline and NICE may work with external partners to help with this.

Implementation resources which have been jointly developed by NICE in collaboration with key national partner organisations, can be co‑badged and carry the NICE logo, providing they are approved by a director and the placement of the logo is approved by the communications team.

Organisations other than NICE may produce resources for guideline implementation. These could include implementation and adoption resources, learning modules/educational packages and patient decision aids. These resources can be endorsed by NICE. A guideline should usually only link to externally developed tools and resources when the tools and resources have been endorsed by the NICE endorsement programme. Endorsement confirms that the resources accurately reflect the content of the NICE guideline and can be updated as needed. Endorsed resources do not carry the NICE logo. If developers identify a relevant tool during development of a guideline, they should contact the endorsement team.

NICE also publishes shared learning case studies, which show how organisations have put our recommendations into practice. If developers hear about any examples of good practice, they should contact the shared learning team.

If a guideline is expected to have a significant resource impact or be challenging to implement, the Guideline Resource and Implementation Panel reviews it, and advises on affordability and workforce issues. The panel works with NICE to produce a statement to support implementation; the statement is published alongside the guideline. The panel includes representatives from NICE, NHS England, NHS Improvement and Health Education England, along with topic experts and other national organisations if needed.

12.5 Other NICE implementation support

The following services and resources help to put all NICE guidance and standards into practice:

  • The implementation support team at NICE works with national partners to support implementation.

  • Members of the NICE field team support local organisations to implement NICE guidance and use quality standards.

  • NICE medicines and prescribing associates and the medicines education team use their local networks to deliver specialist support for high-quality, cost-effective prescribing and medicines optimisation.

  • NICE publishes reports and a database on uptake of NICE recommendations.

  • NICE into practice resources cover the principles of changing practice and practical steps to implement NICE recommendations.

  • An implementation strategy group made up of external academics meets twice a year to inform the NICE implementation strategy with new and ongoing developments in implementation science.

  • NICE's public involvement team works with national and local voluntary and community sector organisations and members of the public to promote the use of our guidance and standards, and support implementation.

We also seek feedback from people who use our guidelines to make them, and any resources to support implementation, as easy to use as possible.

12.6 References and further reading

Auerbach AD, Landefeld CS, Shojania KG (2007) The tension between needing to improve care and knowing how to do it. New England Journal of Medicine 357: 608–13

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 issue 3: CD005470

Cabana MD, Rand CS, Powe NR et al. (1999) Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 282: 1458–65

Eccles M, Grimshaw J, Walker A et al. (2005) Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. Journal of Clinical Epidemiology 58: 107–12

Kneale D, Goldman R, Thomas J (2016) A scoping review characterising the activities and landscape around implementing NICE guidance [online; accessed 11 October 2018]

Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley

Michie S, Johnston M, Hardeman W et al. (2008) From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change. Techniques in Applied Psychology: An International Review 57: 660–80