Washington state’s public workers’ compensation system has had a formal process for developing and implementing evidence-based clinical practice guidelines since 2007. Collaborating with the Industrial Insurance Medical Advisory Committee and clinicians from the medical community, the Office of the Medical Director has provided leadership and staff support necessary to develop guidelines that have improved outcomes and reduced the number of potentially harmful procedures. Guidelines are selected according to a prioritization schema and follow a development process consistent with that of the national Institute of Medicine. Evaluation criteria are also applied. Guidelines continue to be developed to provide clinical recommendations for optimizing care and reducing risk of harm.