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Barriers and facilitators have been classified in many different ways. Here are some examples of common barriers and facilitators identified in the literature at the micro, meso and macro levels, as well as characteristics of the change or intervention itself (Geerligs et al., 2018; Holleman et al., 2009; Solomons & Spross, 2011; Vogel et al., 2016).
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Micro (Individual) Factors
Attitude, knowledge and skills of staff
Barriers
- negative attitudes and beliefs towards the change initiative or the tasks involved in carrying out the change
- lack of capacity to influence change
- lack of confidence or overcome barriers posed by the target population and their work environment
- lack of awareness of, or access to, evidence
- colleagues do not use or value evidence
- concerns that evidence is not relevant to staff or the population served, or that using guidelines will reduce autonomy or interfere with individualized care
- a lack of knowledge or skill to use evidence.
Facilitators
- positive attitudes and beliefs about the change initiative
- high commitment to the change initiative
- staff members who are knowledgeable about the evidence and have the skills to carry out the change initiative
- changes align with work roles and responsibilities
- colleagues value evidence
- a belief that the use of evidence improves practice, decision-making and communication with colleagues
- evidence is accessible: it is fast and easy to access at the point of care (e.g., through the use of flowcharts and algorithms) and integrated into the workflow.
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Meso (Organizational) Factors
Organizational Culture
Barriers
- an organizational culture that is resistant to change
- a culture where blaming others is common
- a risk-averse culture
- a common sentiment that “this is how it has always been done”
- major organizational changes that distract or overwhelm the staff.
Facilitators
- a culture that is open to innovation, revitalization and change
- an organizational priority for evidence-informed practice and continuous quality improvement
- a collaborative workplace where people openly exchange ideas.
Leadership
Barriers
- hierarchical leadership
- authoritarian leaders
- lack of effective communication
- lack of role clarity.
Facilitators
- transformational and authentic leaders
- supportive leadership at multiple levels (e.g., from point of care staff to senior executives)
- formal leaders are present and show visible support and enthusiasm for evidence-informed practice and change initiatives.
- leaders support risk-taking and encourage staff to propose new ideas and share decision-making.
Resources
Barriers
- lack of time to implement changes
- lack of appropriate supplies, technology, well-functioning equipment, staffing, computer access.
Facilitators
- time and support for learning, mentorship, multidisciplinary collaboration
- financial and human resources to support the change initiative.
Staff Engagement
Barriers
- staff not authentically engaged in change initiative or engaged too late in the change process
- the perception that one group has all the knowledge.
Facilitators
- staff feel ‘ownership’ of the change initiative
- staff are involved in designing practice and policy changes and feel like their ideas are valued
- multidisciplinary discussions and open communication
- use of champions to motivate peers, educate, role model best practices, and evaluate the change initiative.
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Macro (System) Factors
Policy
Barriers
- Lack of policies to mandate the change
- Lack of policies to support the implementation
- Existing government policies prohibit the implementation of the change.
Facilitators
- Existing policies in place to support the implementation
- The government recognizes the need for health policy changes to accommodate for new practice changes.
Characteristics of the Change/ Intervention
Barriers
- the change initiative is complex
- the change initiative is costly
- the change initiative is not acceptable to the organization, staff or persons/patients and families
- goals or implementation strategies are unclear.
Facilitators
- the change initiative ‘fits’ well with the context or culture of the organization
- the goals and methodology of the change initiative are clear
- the change can adapt to the setting.
