1031. Mental Models of Clinical Practice Guidelines: Implementation Implications
Sylvia J Hysong, PhD, VERDICT, RG Best, VERDICT, JA Pugh, VERDICT

Objectives: This study examined how primary care personnel’s conceptions of clinical practice guidelines (i.e., their mental models) varied from (a) the VHA’s directive on clinical practice guidelines and (b) from each other, as well as their potential impact on guideline implementation.

Methods: 197 employees at different levels in the organization were interviewed, representing 15 facilities from four VISNs chosen for their EPRP performance (1 high performing VISN, 1 low performer, and 2 improvers). Participants described their mental models of guidelines, how guidelines were implemented at their facility, and other information indicative of their existing facility culture.

Results: Qualitative, grounded theory analyses indicated that employees’ mental models of clinical practice guidelines varied widely, but could be classified into three classes: (a) quality of care models, (b) administrative/pragmatic models, and (c) models exhibiting resistance to guidelines. A significant proportion of mental models reflected ideas that were at best only moderately congruent with the VA directive. Finally, high performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a culture that was supportive of guideline implementation; most, though not all, low performing facilities lacked a clear mental model of guidelines; all low performing facilities lacked a guideline-supportive culture.

Conclusions: A shared mental model of guidelines is a necessary but not sufficient step toward successful guideline implementation.

Impact: Efforts should be made to make the intent of guidelines clear and to promote a culture of learning rather than punitive scrutiny.