The interactional work of translating clinical practice guidelines in primary care organisations: a microethnographic study of professionals’ meetings

Implementation science has long emphasised interactive strategies in advancing knowledge translation in healthcare organisations. Various types of meetings, for example, are widely used to share information and align professionals’ views with recommendations. Yet there is limited empirical understanding of how translation of evidence is accomplished in such settings at the level of social interaction. This study addresses the gap by analysing how updated clinical practice guidelines (CPGs) were negotiated in Finnish primary care meetings. A video-based microethnographic approach was employed to examine eight routine meetings (4–43 participants) across five Finnish primary care organisations, where recently updated national CPGs were discussed. The dataset comprised video recordings of routine organisational meetings (not researcher-initiated), supported by ethnographic background data. Analytic tools from Conversation Analysis were applied to identify recurring interactional activities through which recommendations were translated. We identified four recurring interactional activities through which healthcare professionals collaboratively worked to translate CPGs into local practices: (1) identifying revisions, (2) assessing those revisions, (3) negotiating their meaning, and (4) adapting them to the local context. Through these activities, professionals build shared understanding of revisions and their implications to local practice. However, difficulties in these activities often resulted in stalled translation work. The findings illustrate how routine interactions shape the emergence of local applications of guidelines, and how difficulties observable at the level of interaction may contribute to unwarranted outcomes, such as practice variation. The study demonstrates how guideline translation is accomplished through situated interactional activities in routine healthcare meetings. By making micro-level interactional processes visible, it provides insights into features of meeting interaction that may support or hinder the translation of guidelines into local practice. Methodologically, the study highlights the value of combining video-recorded data from naturally occurring institutional settings with EM/CA-informed microanalytic methods to examine the often implicit layer of interaction through which implementation efforts are accomplished in practice.