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).
Micro (Individual) Factors
Attitude, knowledge and skills of staff
- 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.
Meso (Organizational) Factors
- 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.
- hierarchical leadership
- authoritarian leaders
- lack of effective communication
- lack of role clarity.
- lack of time to implement changes
- lack of appropriate supplies, technology, well-functioning equipment, staffing, computer access.
- staff not authentically engaged in change initiative or engaged too late in the change process
- the perception that one group has all the knowledge.
Macro (System) Factors
- Lack of policies to mandate the change
- Lack of policies to support the implementation
- Existing government policies prohibit the implementation of the change.
Characteristics of the Change/ Intervention
- 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.