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<p>Clinical guidelines (CGs) can improve the quality of care in tertiary hospitals—but only if they are actually used. Past reviews listed facilitators, but did not explain why some work and others fail. This review fills that gap by asking: Under what conditions do facilitators succeed? We systematically reviewed 6948 records (PubMed, Scopus, Web of Science, Magiran, SID) through Nov 2025, selecting 45 high-quality studies. Using the MMAT tool and analytical thematic synthesis, we looked beyond what works to how and when it works. We found that three groups—policymakers, developers, and implementers—must work together in a cycle. Crucially, their actions only succeed under specific conditions: leadership helps only when it is visible, supported by resources, and accountable—not when it is top-down only, CGs are used more when they fit into daily workflow (e.g., emergency kits)—not just when they are simple or short, policies succeed only when paired with practical support (e.g., payment for guideline-based care, feedback systems). We also found that different health systems need different strategies: centralized systems need strong policy integration; high-autonomy settings need peer-led change; resource-limited settings need simple, adaptable tools. Successful implementation is not about more facilitators—but about better-aligned ones. We recommend a shift from top-down orders to collaborative, context-aware planning, where frontline staff, managers, and policymakers co-design solutions.</p>

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Facilitators of Clinical Guideline Implementation in Tertiary Care: A Systematic Literature Review

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Mina Azizzadeh,
  • Sakineh Hajebrahimi,
  • Ali Janati,
  • Javad Babaie

摘要

Clinical guidelines (CGs) can improve the quality of care in tertiary hospitals—but only if they are actually used. Past reviews listed facilitators, but did not explain why some work and others fail. This review fills that gap by asking: Under what conditions do facilitators succeed? We systematically reviewed 6948 records (PubMed, Scopus, Web of Science, Magiran, SID) through Nov 2025, selecting 45 high-quality studies. Using the MMAT tool and analytical thematic synthesis, we looked beyond what works to how and when it works. We found that three groups—policymakers, developers, and implementers—must work together in a cycle. Crucially, their actions only succeed under specific conditions: leadership helps only when it is visible, supported by resources, and accountable—not when it is top-down only, CGs are used more when they fit into daily workflow (e.g., emergency kits)—not just when they are simple or short, policies succeed only when paired with practical support (e.g., payment for guideline-based care, feedback systems). We also found that different health systems need different strategies: centralized systems need strong policy integration; high-autonomy settings need peer-led change; resource-limited settings need simple, adaptable tools. Successful implementation is not about more facilitators—but about better-aligned ones. We recommend a shift from top-down orders to collaborative, context-aware planning, where frontline staff, managers, and policymakers co-design solutions.