Living guideline development is an innovation at the tipping point of major adoption; it is ready to cross the “chasm” of innovation diffusion. But first, we need more leadership in two key areas: development workflow and technical practices. For that, we should look towards software development for key concepts and practices.
Guidelines as technology
Technology is broadly defined as the application of scientific knowledge for achieving practical purposes. Healthcare guideline development is the application of guideline development science, a multidisciplinary field that includes medical science, epidemiology, statistics, psychology, sociology, anthropology, economics, and philosophy.
Healthcare guidelines are technology: the application of scientific knowledge to achieve better health outcomes.
The Diffusion of Innovation
The “Theory of Innovation Diffusion” states that adoption of innovations over time typically has a bell-shaped curve and that adopters can be broken into 5 categories(1):
Innovators
Early Adopters
Early Majority
Late Majority
Laggards
The Innovators and Early Adopters compose the first 15% of individuals who adopt a new innovation; the Early Majority and Late Majority make up the next 68%, while the Laggards are the final 16% of adopters. Importantly, there is often a “chasm”, or disruption in adoption, between the early adopters and early majority. This chasm results from normal human behavior in the face of significant change: most people are only willing to try something new if someone else has tried it first and found it successful.
Based on Rogers EM et al., Diffusion of Innovations(2)
Finding a way to bridge the chasm between the Early Adopters and Early Majority is crucial to ensure wide-spread adoption of innovations; this bridge is commonly referred to as the “tipping point”.
The Chasm in Living Guideline Development
Diffusion of living guidelines, as a technology, is hampered by a lack of leadership. Guideline development, like all product development, requires leadership in the following areas.(3)
The guideline community has already produced frameworks(4) and checklists(5) that outline the value and technical design of producing living guidelines. But leadership, particularly for guideline development programs, is missing in two key areas: development workflow and development technical practices.
Guideline development organizations have historically relied on traditional project management practices that use highly detailed plan-based strategies which are rooted in hardware development. Hardware are physical products, their production is highly routine and changes to production are usually difficult and costly. Unfortunately, many hardware-based project management practices do not adequately account for the high variability inherent in guideline development. Use of these practices lead to major disruptions in normal workflow which limit work capacity and make it extremely challenging to scale Living Guideline Frameworks.
In contrast, software products are immaterial, production is highly variable and therefore project planning must be adaptive to suit the needs of the product as it’s developed. Thus, guideline developing organizations should study management practices used in software development and identify appropriate strategies for guideline development workflow and technical practices.
Developing leadership in these two key areas, development workflow and technical practices, is necessary to ensure that guideline developers are able to bridge the chasm of innovation diffusion. Without leadership in these areas, producing living guidelines at scale will be too costly and disruptive to normal workflows, and their adoption will not extend beyond the tipping point of major adoption.
References:
Rogers, Everett M., Arvind Singhal, and Margaret M. Quinlan. "Diffusion of innovations." An integrated approach to communication theory and research. Routledge, 2014. 432-448.
Berg et. al. Agile 2: The Next Iteration of Agile. 2021. Wiley
El Mikati et al. A Framework for the Development of Living Practice Guidelines in Health Care. Ann Intern Med. doi:10.7326/M22-0514
Schünemann, Holger J et al. “Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.” CMAJ : Canadian Medical Association journal. 186,3 (2014): E123-42. doi:10.1503/cmaj.131237
Comments