title: Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.
abstract: 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.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. k.checkland@btinternet.com
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrison
authors.forename: Martin
authors.initials: M
authors.lastname: Marshall
mesh_terms: 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*