The IMO welcomed the Draft Quality Assurance Criteria for Clinical Guidelines which with further development and application has the potential to be a very useful tool. In a detailed submission to HIQA the IMO pointed out the need for flexibility in the development of guidelines:

• Classical Quality Assurance (QA) seeks to control to a quality standard removing variation both below and above the standard chosen. QA guidelines should not require clinicians that provide excellent care to dumb down.
• While Clinical Guidelines are designed to be applied to groups (population care), clinical practitioners are required to respond to the expectation of patients for personalised care. Clinicians judge the effectiveness and appropriateness of care by monitoring individual patient response and need to be able to react to this clinical feedback on the effects of any guidance they may be following. Guidelines are to be adhered to only if they result in an optimal clinical outcome.
• Medical Practitioners have a paramount responsibility to act in the best interest of a patient and to advise patients on the different options of care available to them including the most effective care. It is not appropriate for a clinical guideline that is constrained by resources to propose conflict with this requirement.
• Medical practice is a dynamic process and guidelines are quickly dated. Practitioners will be up to date in their field of practice through CPD/CME. Provision should be made for clinicians to modify guidelines accordingly.