Challenges and Best Practice

Seven doors from which to choose
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The barriers to implementing change are numerous and occur at multiple levels.  Castiglione and Lavoie-Tremblay (2021) undertook an integrative review of the barriers and facilitators of large-scale change in healthcare organisations.  They identified 20 publications related to these projects which included hospitals, ambulatory or community care, primary care, nursing homes, or other secondary levels of care.  Seven organisational level factors were consistently found to be barriers/facilitators to large scale change: infrastructure support, organisational culture, leadership, change management approach, roles and responsibilities, networks, and measurement and feedback.  A summary and description of these factors can be found in Summary of Factors That Contributed to Successful Large Scale Change.


Some organisations assess their organisation’s readiness before implementing change.  An example of this is a 600-bed hospital in the UK that planned to implement a multidisciplinary assessment for acute stroke care (Hamilton et al, 2007).  Data collection included document analysis, focus groups with professional staff, interviews with senior professional staff and discharge patients and a questionnaire of all professional staff involved in stroke care. The interviews and focus groups were used to elicit the views and experiences of the professional staff who would be affected by the change.  They identified a complex mix of organisational, teamwork, and assessment-related factors that would be barriers and facilitators to/of the proposed change and recommended these assessments so that implementation strategies could be tailored to a specific organisational context.


It is estimated that 70 percent of organisational changes fail to achieve their desired outcomes.  Interviews with physicians and nurses across multiple sectors suggested that there are three key characteristics of successful changes: having the opportunity to influence the change; being prepared for the change and valuing the change (Nilson et al, 2020).


Activity #1

Read the following short guide on how to understand, identify and overcome barriers to change.

The  National Institute for Health and Clinical Excellence has published a short guide on How to Change Practice – Understand, identify and overcome barriers to change (2007).


Activity #2

Read the following case study about introducing a new documentation system.

Walker AR.  2006. Case Study: Leading Change across Two Sites: Introduction of a New Documentation System. Nursing leadership (Toronto, Ont.). 19(4): 34.


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Leadership for Nurses in Clinical Settings Copyright © 2022 by Dr. Kirsten Woodend, Dr. Catherine Thibeault, Dr. Manon Lemonde, Dr. Janet McCabe is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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