Significance and effect of guidelines 1. Some observations ­concerning paradigms with respect to guidelines

Clinical guidelines are currently receiving considerable attention. An important goals of guidelines are to improve the quality of care and to increase patient safety. Linguistic, legal and (proto)-professional paradigms differ on the meaning, scope and effectiveness of guidelines. The underlying propositions are very different. Since guidelines lack uniformity, the benefit of guidelines on the quality of care is unclear. In the use of the term guideline there is the implicit assumption that the significance and effect of a guideline remain unchanged in a changed context. In essence, this is an epistemological problem that to date has not been included in the debate. The consequence is that the effect of guidelines is changing from being a supporting instrument at the patient’s level to becoming an enforceable standard in order to control the collective care process. In addition, it is questionable whether guidelines are the obvious choice to achieve greater quality and safety in healthcare. It is recommended to anchor the paradigmatic origin of guidelines within the law and the guidelines themselves.