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Table 3 New recommendations proposed by study team

From: Navigating barriers: two-year follow up on recommendations to improve the use of maternal health guidelines in Kosovo

New proposed recommendation Relevant recommendations from 2012 Possible next steps to operationalize recommendation Policy and intervention functions addressed by activities
A) Develop a guideline development/adaptations working group to create or adapt maternal and perinatal health guidelines. #8: Consider engaging some of the local clinicians on the WHO guidelines development group. Guideline for critical appraisal:
• Prioritize a WHO guideline to critically appraise within the local context (for example using AGREE II).
• Could link with data collection group to identify topics with higher needs (e.g., PPH).
• Liaise with people who have been trained in critical appraisal or complete online AGREE training (see recommendation C).
Guideline adaptation:
• Identify whether the guideline needs to be adapted to the local context.
• Liaise with the people who have been trained in guideline adaptation (see recommendation E).
• Adapt guideline to local context using ADAPTE process.
Policy functions:
• Guidelines
• Regulation
B) Develop a guideline implementation working group to pilot test an evidence-informed implementation strategy to support guideline implementation, then scale up the initiative. #5: Create a guideline implementation working group with representative stakeholders at the local level.
#2: Incorporate standards into clinical practice including a monitoring system for guideline adherence.
Explore networking opportunities:
• Work with stakeholders who have started implementation activities locally or in other countries.
• Liaise with those developing centralized data systems to use data whenever possible in the evaluation (see recommendation D).
• Invite members from the new division in the MOH focusing on monitoring and evaluating health services.
Secure resources:
• Apply for seed grant funding from GREAT Network in Fall 2015 building on existing initiatives.
• Seek funding to scale up the project.
• Send 1–2 people to a KT practice course to learn about how to apply the science of implementation.
Start small and scale up:
• Implement and evaluate a pilot project – prioritize initiatives that emphasize increased communication and motivation (themes 1 and 2).
Pilot project could address some or all of the following intervention functions:
• Education
• Training
• Persuasion
• Modeling
• Enablement
C) Develop guideline policy working group to work collaboratively with the MOH and clinician stakeholders to identify and support opportunities to engage in policy changes related to guideline implementation. #6: Develop a small working group with local representatives from clinician groups, the MOH guidelines committee and quality portfolio, clinical or health services researchers, and the WHO to move forward with implementation. • Work on building strong relationships across stakeholder groups (recommendation A).
• Maximize opportunities to involve outsiders in work (e.g., MOH on clinician-led initiatives and clinicians on MOH-led initiatives).
• Work with MOH to identify opportunities to embed guideline implementation changes at a policy level (e.g., through the new monitoring and evaluation division of MOH and the national level performance based incentive program).
• Prepare evidence briefs on guidelines for policymakers.
• Use KT Platform model examples from other countries such as Malawi and Uganda.
Policy functions:
• Regulation
• Fiscal measures
• Legislation
• Communications/marketing
Intervention functions:
• Environmental restructuring
D) Continue to develop and operationalize a centralized system for data collection. #1: Create a centralized system for data collection across clinical settings as well as for formal and informal channels for practice sharing. • Continue with efforts to develop a centralized data collection system.
• Create a working group to identify key success factors in locally driven initiatives.
• Connect with other working groups to support guideline development and implementation efforts.
Policy functions:
• Environmental/social planning
• Regulation
Intervention functions:
• Environmental restructuring
E) Expand guideline development and implementation capacity building and networking activities. #7: Consider offering workshops on guideline development methods, including use of GRADE (Guyatt et al., 2008), on appraisal of guidelines using AGREE, and on guidelines adaptation (National Collaborating Centre for Methods and Tools [NCCMT], 2011), for representatives from the MOH and clinical groups.
#9: Engage those interested in guideline development and implementation from neighbouring countries in the workshop activities and create a ‘virtual’ community of practice to share experiences and avoid duplication of effort.
• Build a capacity building working group or community of practice.
• Liaise with other working groups to continue to build capacity and support ongoing activities.
• Find education/training opportunities including:
o AGREE II tool - critical appraisals
o ADAPTE process and toolkit – guideline adaptation
o Systematic reviews
o Pragmatic trials
• KT practice/implementation to develop a train-the-trainer model, where those who have been trained have an opportunity to share what they learned locally.
• Use implementation coaching to provide technical support during ongoing implementation efforts.
Intervention functions:
• Education
• Training
• Enablement