The study of factors affecting the implementation of clinical guidelines in Iran

Clinical guidelines are categorized and provide information in order to help the decision-making of medical teams, with the aim of improving patients care. Therefore, this study aims to identify the factors influencing the implementation of clinical guidelines in Iran. This is a descriptive-analytical study performed in 2018‒2019. The study population consisted of managers and experts working in healthcare. A total of 470 subjects were chosen by the multi-stage sampling method. A researcher-made questionnaire was used to collect data. The validity of the questionnaire was investigated by means of the experts’ opinions, its reliability was assessed using the combined reliability test, and the internal consistency of the questionnaire was examined by Cronbach’s alpha (0.934). Exploratory factor analysis and SPSS-18 software were used for data analysis. In the exploratory factor analysis, 47 variables were identified and divided into six components. In the component of the features of the clinical guidelines; the elimination of ambiguity and the existence of a clear protocol with a load factor of 0.80, in the component of the organizational culture factors; informing the patient with a load factor of 0.77, in the component of economic factors; the existence of budget and elimination of restrictions with a factor load of 0.74, in the component of insurance factors; the insurance tariffs with a load factor of 0.75, in the health system’s trusteeship component; the existence of an evidence-based practical system with a factor load of 0.69, and in the organizational factors component; the changed attitude of the staff and group work with a coefficient (factor load) of 0.6 have had the greatest influence on the implementation of clinical guidelines in Iran. Accessibility to information, motivation creation and attitude change, effective management, creation of systematic vision and appropriate feedback, as well as the establishment of relevant standards for work processes are effective strategies for implementing guidelines.