based on available evidence along with open consultation and peer review. Full details of the methodology are available on our website (www.sign.ac.uk).


Why is evidence graded and how do healthcare professionals make use of that? KB: All SIGN recommendations are graded to reflect the underlying quality of the evidence which supported the recommendation. Most importantly the grade of the recommendation does not reflect its clinical importance. For example, in our postnatal depression guideline we have a recommendation that ‘PND and puerperal psychosis should be treated’. Tis is clearly the most important recommendation, but it is a Grade B recommendation, reflecting the fact that randomised controlled trials comparing treatment with no treatment don’t exist and are unlikely to be carried out in the future.


How do you avoid bias in guideline development? KB: Research shows that guidelines are less susceptible to bias if they are developed by multi-disciplinary groups involving all the relevant specialties, recommendations are based on a systematic review of the evidence and all declarations of interest are recorded and acted upon. We base our methodology around these principles.


How long does it normally take between proposal and publication? ST: A long time! Once we’ve had agreement to develop a guideline we need to find a ‘slot’ in the guideline programme and then identify the chair and the guideline development group. Te development process for a new topic then takes around two years, so it may take up to four years from proposal to guideline. We agree this is too long, but what we can do about it is another matter – all guideline developers have this sort of issue.


What is a SIGN ROCKET? ST: SIGN ROCKETs are online summaries of our guidelines that allow you to manoeuvre, click by click, quickly around the clinical content to help you find the specific piece of information that you are looking for. ROCKETS are based on our quick reference guides, but may contain additional supporting material from the full guideline.


WINTER 2012


How has the focus at SIGN shiſted from guideline development to implementation? KB: Over the last few years we have recognised that an implementation strategy based around sending hard copies out to healthcare professionals isn’t really the best. We therefore looked at the literature on implementation support and have come up with an approach which is multi- faceted. Most importantly we actively involve the multi-disciplinary group in thinking about implementation support during the development process, rather than as an add-on at the end. We also


of different formats to maximise dissemination. Credit for the original app idea should go to Safia Qureshi, our previous Programme Director, but Stuart Neville, Publications Coordinator, and Roberta James, Programme Director, were the team who worked with an app developer to get it in its current form. Te app is based on the quick reference guide of each guideline, with some additional material. It is available free of charge for Apple phones, iPads and Android phones. We now have more than 31,000 downloads, so the message is getting out there.


“All SIGN recommendations are graded to reflect the underlying quality of the evidence...”


publish an implementation strategy for each guideline at the time of launch.


You recently launched You Tube broadcasts for patients. How does the SIGN remit extend to patients? KB: Everything we do is ultimately for the benefit of patients, so provision of information about guidelines and our work in easily accessible language is important. We have patient involvement in everything we do, led by Karen Graham our Patient Involvement Co-ordinator, who supports the patients and carers on our groups. We provide patient versions of many of our guidelines in both electronic and paper form and we are about to provide our first Smartphone app designed wholly for patients. We are advised that YouTube is a good way of reaching a wide range of people, so watch this space for more broadcasts.


Congratulations on your recent award from eHealth for the SIGN guideline app. How does this work and how did the idea come about? ST:Tank you. As part of our refocusing on implementation support we recognised that we need to produce guidelines in lots


What do you enjoy most about your job? ST: Two main things – firstly the opportunity to make a difference to the healthcare of thousands of patients every year by working with front-line clinicians to produce high-quality, Scottish-relevant, recommendations for clinical practice. Secondly, working with the SIGN team, who are a great bunch of people and are all willing to go the extra mile to produce a fantastic product.


KB: Te opportunity to work within an organisation as internationally respected as SIGN.


What do you find most frustrating? ST: NHS bureaucracy!


KB: Ill-considered change which is more of a challenge than an opportunity.


Are there any special challenges to providing healthcare guidelines in Scotland? ST: Scotland is a small country and when embarking on a specialist topic, forming a guideline development group may result in inviting all of the specialists in Scotland onto the group. Obviously this has consequences for the service but also creates the possibility of bias in the process. More challenging is managing expectations – we would all love to have completely up- to-date guidelines on every topic, but this is just not possible given the resources available to us. Other challenges aren’t particularly Scotland specific, such as problems with people being released to work on guidelines, which is true of all national activities.


Interview by Jim Killgore 11


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