Experience, evidence and everyday practice : creating systems for delivering effective health care

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Practical experience gained by those involved in the 16 P.A.C.E. projects and the emerging research evidence about changing clinical practice and developing organisations provide the basis for this report. It draws together the essential attributes of the successful management of implementation initiatives. The experience of the project has confirmed that a multi-faceted approach can be successful, but that implementation is messy, is not linear, takes time and is expensive. Ten essential tasks have been identified which when used together as components of an implementation programme can lead to success. These are: choosing when to start; engaging clinicians; involving patients; defining local standards; keeping in touch; securing change; providing services; measuring impact; sustaining change; and learning lessons. Effective local arrangements for clinical governance will require organisations to put in place systems to assure the delivery of high quality health care. The experience of P.A.C.E. suggests that five linked systems are required: to enable quality of clinical practice to be routinely reviewed; to ensure that standards for care can be established; to ensure that patients are at the centre of work to develop and monitor local standards; to ensure that implementation is managed effectively; and to support the development of individuals and teams through education and training.

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