The development of good guidelines does not ensure their use in practice. Lomas1 has observed the multitude of factors that influence healthcare professionals' behaviour and this has led to increased recognition of potential barriers and facilitators to implementation at various levels: the organisation, the peer group and for the individual clinician. There­ fore, to maximise the likelihood of a clinical practice guideline being used, we need coherent dissemination and implementation strategies to capita­ lise on known facilitators and to address identified barriers. In this chapter we discuss how healthcare organisations (e.g. hospitals, general practices) and individual clinicians can use clinical practice guidelines to improve clinical effectiveness. We suggest that there are two broad methods of effective guideline use, both of which should be planned, proactive processes. First, healthcare organisations may use guidelines as tools within planned quality improvement activities. Second, individual healthcare professionals may use guidelines as an information source for continuing professional educational development and to answer specific clinical questions arising out of their day-to-day practice.2-3

Using clinical guidelines within healthcare organisations The dissemination and implementation of guidelines as part of quality improvement activities within a healthcare organisation require planning, commitment, enthusiasm and resources. Quality improvement implies a cyclical process involving priority setting, implementation, assessment of performance (using clinical audit) and further implementation.