Moving Beyond Dusty Guidelines: Developing a National Clinical Practice Guidelines Dissemination and Implementation Model for Aotearoa New Zealand's Maternity System
Clinical practice guidelines bridge cutting-edge research and the best evidence-based practice in maternity care. They are critical tools to address provider factors contributing to preventable maternal morbidity and mortality. This mixed methods comparative ethnographic research study utilised three districts health boards (DHBs) of varying sizes (Capital and Coast, Hutt Valley and Hauora Tairāwhiti) to address the study’s primary research question: How can Aotearoa New Zealand's maternity system disseminate and implement the national clinical practice guideline on hypertension and preeclampsia to integrate best clinical practices into standard care? The research identified barriers and facilitators to disseminating and implementing national maternity clinical practice guidelines and developed a new maternity clinical practice guideline dissemination and implementation model. The methodology comprised an electronic clinicians survey, semi-structured key informant interviews, field notes, an analysis of relevant policy documents and reports and selected published media. The sample involved 34 key informants (national and local maternity stakeholders) and 91 maternity clinician survey respondents. Significant barriers to integrating maternity clinical practice guidelines included understaffing, limited funding, technology gaps, a hierarchical organisational culture, embedded inequities, and no maternity clinical practice guideline dissemination and implementation plan. These barriers informed a ten-step maternity clinical practice guideline dissemination and implementation model and a series of maternity quality and safety recommendations that the Aotearoa New Zealand Ministry of Health/Manatū Hauora and the maternity system could use to improve clinical care.(1-3) The recommendations include a more proactive and collaborative role for the Ministry of Health/Manatū Hauora, leveraging existing staffing and systems of care to strengthen maternity quality and safety, fostering Māori and Pasifika leadership in maternity quality and safety, educating consumers on maternity clinical practice guideline recommendations, bridging technology gaps to implement guidelines better, identifying and sharing local best practices that promote quality and safety, and ensuring adequate funding for maternity quality and safety. There has been ongoing dialogue with the Ministry of Health/Manatū Hauora and other stakeholders throughout this research, increasing the likelihood of its translational impact. Although specific to Aotearoa New Zealand, these results are likely applicable in other countries as maternity clinical practice guidelines are used extensively to improve and standardise provider practice.