Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.
OBJECTIVE
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.


CONCLUSIONS
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.
Checkland
Kath
K
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. k.checkland@btinternet.com
Harrison
Stephen
S
Marshall
Martin
M
D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration*; D033161:Government Regulation; D006123:Group Practice / Q000458:organization & administration*; D006284:Health Plan Implementation; D006801:Humans; D007407:Interviews as Topic; D019365:Metaphor; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011057:Politics; D011216:Practice Management, Medical; D036301:Qualitative Research; D012962:Sociology, Medical; D013222:State Medicine / Q000458:organization & administration*