To save time and energy, obtain existing guidelines from the National Heart, Lung and Blood Institute’s NAEPP or the National Guideline Clearinghouse.

Involve a provider champion or your Medical Director in selecting and adapting guidelines, but be certain to obtain consensus on guidelines among the providers you expect to implement them.  Focus initial effort on guidelines that are easily agreed upon.  Do not be sidetracked by controversial topics:  Work on those guidelines later.

Mix and match guidelines as needed.

Set clear expectations and timelines for guideline adaptation, review, and adoption.

Include evidence summaries that accompany good guidelines to facilitate discussion.

Build consensus through compromise and willingness to try. Discuss, negotiate, and prioritze together. 

Send a physician to a Continuing Medical Education on evidence-based medicine. Also, consult article reviews like those on the American Academy of Family Practice website.

To get “buy-in” from influential naysayers, involve them in the process.

Do not get mired down in complex algorithms or standards of care.

Keep chart abstraction simple and quick: Collect only the data that are needed.

Have providers abstract a random sample of their own charts.  This helps them discover the gap between what they know is good practice and what they actually do. Maybe have a “lunch and learn” session to pull this off.

Try to integrate the chart audit with development of the registry.  Talk to other clinics that have already customized guidelines to get the fastest process in place.

Make it as hard as possible to ignore the guideline.

Try different ways of getting the flow sheet in the chart.

Ask teams that are already practicing evidence-based medicine to spread the word.  If a team is not practicing this way, have them visit another clinic that is.

Think about why guideline implementation is not working

Discuss which of these factors is playing a role.  You may have to address multiple issues simultaneously.