Health and Work Development Unit 2011 Implementing NICE public health guidance for the workplace: Implementation and audit action planning toolkit

B. How to change organisational practice

The purpose of this section is to help you to understand: how to identify the barriers to change in your organisation the different types of barriers and why change may be difficult how to overcome these barriers.

Healthcare organisations typically face barriers in 6 main areas: 1.awareness and knowledge 2.motivation 3.skills 4.acceptance and beliefs 5.practicalities 6.the external environment. These will be detailed in the next slides.

1. Awareness and knowledge Awareness and knowledge of what needs to change, and why, are crucial to enable change to occur. Evidence shows that professionals are often unaware of, or are unfamiliar with, the latest evidence-based guidance. Guidance can be seen to undermine a professional’s autonomy and be irrelevant for their role.

2. Motivation Motivation is driven by external factors (e.g. the provision of incentives or penalties) and internal factors (e.g. individual’s drive and desire to improve). Priorities and commitments can impact on an individuals’ ability to change.

3. Skills To make change happen, individuals need to know what needs to change and how to carry out the change. Professionals may need training, support from peers or mentoring to ensure they have the relevant skill set and they may need the time to learn the skill and practice it. Individual abilities, interpersonal skills and coping strategies will affect how easy or difficult it will be for an individual to learn a new skill.

4. Acceptance and beliefs An individual’s personal beliefs and attitudes impact on the way they behave. Perceptions of the benefits of any proposed change versus the practical and financial costs can be important. Professionals can find it difficult to accept new evidence- based guidance if it is in conflict with guidance issued by other bodies or the opinion of an influential colleague. Other professionals may not believe that recommendations reflect the evidence or that they will achieve better organisational, staff, and ultimately, patient outcomes.

5. Practicalities Practical barriers can involve: a lack of resources or personnel difficulties in establishing service delivery availability of equipment and facilities configuration of services or the infrastructure of the organisation maintaining change in the long term - if key members of staff leave or priorities shift it may be difficult to maintain any changes that have been introduced.

6. The external environment – barriers beyond our control The financial and political environment can impact on a professional’s desire, motivation and ability to make changes. Incentive mechanisms and regulatory processes may not be aligned with what is needed to implement the changes.

Equipped with an understanding of the types of barriers faced in healthcare, you now need to identify the barriers that your team, department and organisation faces. At the end of the meeting you will review the specific barriers for your team, department and organisation in relation to the guidance.

How can you identify your barriers? brainstorm focus groups questionnaires talk to key individuals

Barriers can be overcome using simple tools educational materials clinical audit and feedback reminder systems educational meetings opinion leaders staff consultation staff engagement