Testing of draft guidelines as a form of pilot implementation

Introduction
Poor or suboptimal implementation is often the achilles heel of adherence to evidence based guidelines in occupational healthcare in daily practice. Implementation can be improved if, during the guideline development, a test on feasibility in practice is carried out with a draft of the guideline. The results of the practice test can be used to adapt and tailor the final version of the guideline. Therefore, The Netherlands Society of Occupational Medicine has included a pilot implementation by means of a practice test in its guideline development process. The aim of this test is to evaluate the feasibility in a group of volunteering practitioners; to develop and test training tools; and to gain first experiences from pilot implementation.

Methods
The guideline development group defines a number of performance indicators on key issues of the guideline. Test volunteers are recruited among the members of the Society. They receive a short traing in the new aspects of the draft guideline and are asked to use the guideline in their daily practice and to document their activities in standardized forms. For each case, performance on the chosen indicators is assessed.

Results
So far, practice tests have been carried out in seven different guideline development projects. Performance scores on important topics ranged from 11% correct handling to 95%, indicating ample room for improvement.

Discussion
A practice test is a valuable tool in the guideline development process. It makes the guideline better and the implementation easier. Low group performance scores on one or more indicators indicate problems with feasibility and should lead to adaptation of the guideline or the further implementation plan.