OBJECTIVES:The implementation of best practices in clinical care remains elusive. Evidence based practice guidelines synthesize medical knowledge, but there is a large body of literature substantiating the difficulties of implementing guidelines. Cabana and colleagues provided a review of barriers to physician use of guidelines. In this study we present a review of strategies shown to facilitate guideline implementation and provide a framework to assist organizations in designing guideline implementation strategies. METHODS: We searched the MEDLINE and HealthSTAR databases; bibliographies of articles and references known to us or supplied by authors of guideline studies for English-language studies that describe successful guideline implementation. Articles were included if they were original reports of attempts to implement one or more guidelines and contained information on the process used and whether it was considered a success or failure. We then examined the articles describing successful implementation to identify and categorize methods used to facilitate the success. RESULTS: Of 1156 identified articles, 83 met inclusion criteria and underwent further analysis. Of the 83 articles included, 65 described successful attempts to implement guidelines while 18 described failed attempts. The 65 articles included 70 descriptions of facilitators to guideline implementation. These 70 facilitating methods fell into 7 categories and covered a range of clinical areas. The facilitating methods included 1) data feedback (14/70), 2)reminders or checklists (22/70), 3)peer review and in person feedback (1/70), 4) direct supervision (2/70), 5) in-service or other educational interventions (27/70), 6) mandates (2/70) and 7) monetary incentives (2/70). Studies rarely documented any underlying theoretical beliefs for the success of their programs. We classified the implementation methods as 1) information providing (checklists, education, data feedback), 2) memory prompting (reminders, checklists) or 3) workplace interactive (peer review, supervision, mandates, incentives). We then correlated organizational characteristics with the successful implementation methods to devise a framework for other institutions attempting to implement practice guidelines. CONCLUSIONS: While difficulties in guideline implementation are well documented, there are also many successful implementations with positive impact on patient care and/or clinician satisfaction. Understanding what methods are available and have been successful and how they fit into a given clinical area and organization may improve implementation success.