May 17 2001
In Canada, and to some degree in the United States, there is a somewhat different "spin" on the definition and use of these terms, partly for the ways in which they have been used and abused medicolegally. As an aside, it is curious to me that North America produces ~5% of the world's population but ~50% of the world's lawyers. We should set better standards. I won't go so far as what Lenin suggested.
GUIDELINES
Last's Dictionary of Epidemilogy (Oxford U Press): "A formal statement about a defined task or function...In the terminology developed by the European Community, DIRECTIVES are stronger than RECOMMENDATIONS, which are stronger than GUIDELINES. In North America, GUIDELINES is normal usage also for RECOMMENDATIONS."
In Canada at least, a GUIDELINE is "practice generally recommended". These instruments are variously available and variously catalogued. They are also variable in quality, ranging from parochial and debatable to strongly "evidence-based". However, they are not, and should not be interpreted as STANDARDS. They may vary, and be variously adopted, according to local resources and other circumstances.
PROTOCOL
Last's DOE: "The plan, or set of steps, to be followed in a study or investigation or in an intervention program (aka ALGORITHM)." I think that definition is an adequate answer to that part of your question.
POLICY
Not defined in the DOE but STANDARD is a synonym, with the variance being whether the item is local, regional, national or whatever. A STANDARD in the DOE is: "Something that serves as a basis for comparison: a technical specification or written report drawn up by experts based on the consolidated results of scientific study, technology (?? PFH) and experience, aimed at optimum benefits and approved by a recognized and representative body."
In the Canadian Province of Manitoba, a STANDARD is "a formal position of the College (of Physicians and Surgeons) with which members shall comply". Note the verb.
Forgive an added gratuitous editorial comment, but DOE defines STANDARD ERROR as "the standard deviation of an estimate" but the standard error in North American medicolegal disputes is confusing STANDARDS (POLICY) with GUIDELINES, and to assume that either, or for that matter either term, or "CONSENSUS" is synonymous with best evidence, or best practice.
Sincerely,
Philip F. Hall, MD BScMed FRCSC
Director, Fetal Assessment, Provincial Obstetric Outreach and Maternal-Fetal Medicine Programs
St.Boniface General Hospital, 409 Tache Avenue D2044
Winnipeg, Manitoba, Canada R2H 2A6
ph 204-237-2547 FAX 204-233-1751
(Chair, Obs & Gyn Specialty Committee,
Royal College of Physicians & Surgeons of Canada)
Professor, Faculty of Medicine, University of Manitoba
<www.umanitoba.ca/womens_health>
>>> Christina Maslen <[log in to unmask]> 05/17/01 06:09am >>>
Can anyone tell me how to distinguish between a guideline, a protocol and a policy? These terms are often used interchangeably (even within the same article) and I have clinicians here who want to know what kind of beast
they are developing! Apart from a general understanding that a protocol is more prescriptive about procedures/ processes and guidelines are meant to be more general and flexible and cover clinical conditions...... but where
does a policy fit in?
Hope you can help
Christina Maslen
Clinical Effectiveness Facilitator
RNHRD NHS Trust
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