Personal Factors
A therapist says, "I know the guideline exists, but I have never really seen it before, so I just keep doing what I’ve always done."
What is lack of awareness?
The guideline is 40 pages long, uses dense language, and staff cannot quickly find the key steps during clinic hours.
What is poor layout?
Your team agrees with the CPG, but appointments are already overbooked and there is no time to add the new steps.
What is lack of resources?
A clinician says the guideline sounds good, but she does not feel confident enough to carry it out correctly.
What is lack of self-efficacy?
A pediatric CPG recommendation do not seem realistic for children with multiple diagnoses, so staff ignore them for complex cases
What is lack of applicability OR exclusion of patients with complex disease entities?
In your clinic, different professionals work separately, so no one is sure who is responsible for following the guideline.
What is lack of collaboration?
Dr. X believes that treatment 1 works best for patients post stroke
Dr. Z believes that treatment 2 works best for patients post stroke
What is lack of agreement?
A pediatric occupational therapist wants to use sensory integration techniques for a child who overreacts to classroom noises and textures, but the guideline only cites small pilot studies with no randomized trials showing gains in school participation or self-regulation.
What is lack of evidence?
The adult OT clinic has a guideline recommending standardized dynamometer testing for grip strength to assess risk, but the team prefers informal observation during functional tasks
What is organizational constraints?