National Institute for Health and Clinical Excellence. (2007). How to change practice: Understand, identify and overcome barriers to change. Retrieved from https://www.nice.org.uk/media/default/about/what-we-do/into-practice/support-for-service-improvement-and-audit/how-to-change-practice-barriers-to-change.pdf.
Relevance for Public Health
This guide was developed to support professionals' and managers' change in practice within a clincial setting. However, the strategies outlined would be appropriate for other settings, including public health. For instance, this method could inform the implementation of a surveillance and monitoring system for childhood immunizations.
This method provides practical suggestions to facilitate change in clinical practice. These suggestions are also applicable in public health settings. By understanding barriers at the individual level that may hinder the adoption and implementation of innovation, this guide outlines how to identify and overcome those barriers. This guide is divided into four major sections:
- understanding barriers to change
- identifying barriers to change
- overcoming barriers to change
- mapping barriers to methods.
Accessing the Method/Tool
Implementing the Method/Tool
Time for Participation/Completion
Information not available
Depending on the nature of the innovation and the organization, varying levels of commitment with respect to resources and time would be required.
Additional Resources and/or Skills Needed for Implementation
Steps for Using Method/Tool
This method consists of four sections:
1. Understanding barriers to change
Assess which barriers and facilitators of change are present at the individual level, including:
- lack of awareness and knowledge among practitioners and staff of how current ways of working need to change to align with evidence;
- motivators, both external and internal, such as financial incentives and personal goals and priorities, respectively, or lack of motivators;
- personal beliefs, attitudes and perceptions of change, and the associated risks and benefits of the change;
- individual skills and capacities to carry out the change in practice;
- practical barriers, including lack of resources, equipment or staffing; and the external environment, which can influence the individual's ability to adopt a new intervention, such as financial structuring.
2. Identifying barriers to change
Conduct a baseline assessment to identify the gap between recommended practice and current ways of working. This baseline assessment of barriers permits tailoring implementation of the innovation. Data collections methods used to conduct an assessment of barriers include the following:
- Learn from key individuals with knowledge, authority and skills to speak to implementation of the innovation.
- Observe individuals in practice, especially for routine behaviours.
- Use a questionnaire to explore individuals' knowledge, beliefs, attitudes and behaviour.
- Brainstorm informally in small groups to explore solutions to a problem.
- Conduct a focus group to evaluate current practice and explore new ways of working.
- The developers also discuss potential advantages and disadvantages of each data collection method.
3. Overcoming barriers to change
This section examines different strategies for overcoming barriers to implementing change in practice. The developers outline when specific strategies are used, and briefly discuss evidence of their effectiveness.
Strategies include the following:
- Educational materials (booklets, CD-ROMs, DVDs, etc.) can raise awareness of a new way of working and are effective in changing behaviour when combined with other strategies.
- Informational meetings (conferences, training courses, lectures, etc.) can increase awareness of change. However, informational meetings with interactive participation, like workshops, are more likely to result in behaviour change.
- Educational outreach visits (or academic detailing) involve trained individuals visiting individuals in their organization to offer information and support in adopting new ways of working. Outreach visits are effective in changing certain kinds of behaviour, such as the delivery of preventive services or prescribing behaviour.
- Opinion leaders can influence their colleagues to adopt an innovation. The use of opinion leaders is an effective way of disseminating information
- . Audit and feedback, where information is given back to individuals or teams about their practice as a way to monitor and improve practice, is an effective method for changing behaviour. Audit and feedback is particularly effective when staff buy in and are involved in the process, when feedback is timely and when combined with financial incentives.
- Reminder systems and decision-support systems are effective in changing behaviour, especially at the point of decision-making. Decision support systems are effective for specific decisions, such as delivery of preventative services, and less so for complex decision-making.
- Patient-mediated strategies, which provide information to the general public, are effective in changing the behaviour of practitioners. Such strategies include mass media campaigns, which increase awareness of an innovation among the public and practitioners.
4. Mapping barriers to methods
In this last section, the developers provide a series of questions to assist in conducting a baseline assessment of barriers and include ways of overcoming those barriers. This is followed by two case studies outlining different strategies for overcoming barriers to changing practice, along with a list of additional resources to assist with implementation change.
Who is involved
Various roles would be involved in administering and participating in this method, including individuals at management and service delivery levels. Specific individuals could include: program directors, program coordinators, public health nutritionists, public health nurses, health promotion officers and team leaders.
Conditions for Use
© 2007 National Institute for Health and Clinical Excellence
Evaluation and Measurement Characteristics
Information not available
National Institute for Health and Clinical Excellence (NICE)
Method of Development
This method is one in a series of documents that support implementation of the National Institute for Health and Clinical Excellence (NICE) guidance through the NICE Implementation Strategy. NICE is an independent organization providing national guidance on clinical care to establish and maintain high standards of patient care and safety in England. The NICE Implementation Strategy provides practical resources to support the implementation of NICE guidance into practice.
National Institute for Health and Clinical Excellence
London, UK WC1V 6NA
These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.