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The barriers and facilitators to the implementation of clinical guidance in elective orthopaedic surgery: a qualitative study protocol

Overview of attention for article published in Implementation Science, June 2015
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  • Above-average Attention Score compared to outputs of the same age (55th percentile)

Mentioned by

4 tweeters


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Readers on

51 Mendeley
1 CiteULike
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The barriers and facilitators to the implementation of clinical guidance in elective orthopaedic surgery: a qualitative study protocol
Published in
Implementation Science, June 2015
DOI 10.1186/s13012-015-0273-6
Pubmed ID

Amy Grove, Aileen Clarke, Graeme Currie


Clinical guidelines in orthopaedic surgery aim to improve the efficiency, quality and outcomes of patient care by ensuring that treatment recommendations are based on the best available evidence. The simple provision of guidelines, however, does not ensure fidelity or guarantee their uptake and use in surgical practice. Research exploring the factors that affect surgeons' use of evidence and guidelines has focused on understanding what evidence exists for current clinical decisions. This narrowed scope emphasises the technical, educational and accessibility issues but overlooks wider factors that help explain how and why guidelines are not implemented and used in surgery. It is also important to understand how we can encourage the implementation processes in practice. By taking a social science perspective to examine orthopaedic surgery, we move beyond the narrow focus and explore how and why clinical guidelines struggle to achieve full uptake. We aim to explore guideline uptake to discover the factors that contribute to, or complicate, appropriate implementation in this field. We need to go beyond traditional views and experimental methods to examine the barriers and facilitators of implementation in real-life NHS surgical practice. These could be multifactorial, linked to individual, organisational or contextual influences, which act on the guideline implementation process. We will use ethnographic methods to conduct case studies in three English NHS hospitals. Within each case, we will conduct observations, interviews and analysis of key documents to understand experiences, complex processes and decisions made and the role of clinical guidance and other sources of evidence within orthopaedic surgery. The data will be transcribed and analysed thematically. Comparisons will be made within cases and across cases. Guidelines are a fundamental part of clinical practice, and various factors must be considered when preparing for their successful implementation into organisations. Understanding the views and experiences of a range of surgical, clerical and managerial staff across multiple orthopaedic departments will capture the complexity and variety of factors that can influence surgical decisions. The findings of our study will identify the specific features of orthopaedic practice to help guide the development of strategies to facilitate guideline uptake in everyday surgical work.

Twitter Demographics

The data shown below were collected from the profiles of 4 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 51 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 51 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 12 24%
Researcher 8 16%
Student > Ph. D. Student 7 14%
Other 4 8%
Student > Doctoral Student 4 8%
Other 6 12%
Unknown 10 20%
Readers by discipline Count As %
Medicine and Dentistry 13 25%
Social Sciences 5 10%
Nursing and Health Professions 5 10%
Psychology 3 6%
Business, Management and Accounting 2 4%
Other 7 14%
Unknown 16 31%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 June 2015.
All research outputs
of 7,442,723 outputs
Outputs from Implementation Science
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Outputs of similar age
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Outputs of similar age from Implementation Science
of 56 outputs
Altmetric has tracked 7,442,723 research outputs across all sources so far. This one has received more attention than most of these and is in the 54th percentile.
So far Altmetric has tracked 995 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.6. This one is in the 20th percentile – i.e., 20% of its peers scored the same or lower than it.
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We're also able to compare this research output to 56 others from the same source and published within six weeks on either side of this one. This one is in the 10th percentile – i.e., 10% of its contemporaries scored the same or lower than it.