Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice
Abstract
Objectives: To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Methods: Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. Results: The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. Conclusion: The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.
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Relevant barriers and facilitators are dynamic and likely to change over time.
“Relevant barriers and facilitators are dynamic and likely to change over time [14, 28].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [28]
Barriers reported as separate entities are likely to interact with one another and cannot be considered in isolation.
“Despite many of the barriers being reported as separate entities in the identified reviews, they are likely to interact with one another and each cannot be considered in isolation [28, 32, 47, 94].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [28]
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Cited by 133
- Authors
- Checkland, K., Harrison, S., & Marshall, M.
- Affiliations
- University of Manchester (GB)
- Venue
- Journal of Health Services Research & Policy
- Publisher
- SAGE Publications
- Published
- 2007-04-01
- Volume
- 12
- Issue
- 2
- Pages
- 95-100
- ISSN
- 1355-8196 (ISSN-L)
- 1758-1060
- OpenAlex
- W2170457652
- Cited by
- 133
- References
- 0
- Citations by year
- 2026: 6 · 2025: 1 · 2024: 5 · 2023: 6 · 2022: 22 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 12 · 2015: 7 · 2014: 8 · 2013: 6 · 2012: 6
- FWCI
- 10.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Services Research & Policy (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Management and Organizational Studies
- Keywords
- barriers to change, health policy implementation, National Service Framework, general practice, organizational reality, National Health Service
- MeSH terms
- Attitude of Health Personnel, Diffusion of Innovation, England, Family Practice, Group Practice, Health Plan Implementation, Humans, Interviews as Topic, Organizational Innovation, Politics, Practice Management, Medical, Sociology, Medical, State Medicine, Evidence-Based Medicine, Metaphor, Organizational Case Studies, Government Regulation, Qualitative Research
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