title: Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behaviour change.
abstract: BACKGROUND
  Quality indicators are increasingly used in healthcare but there are various barriers hindering their routine use. To promote the use of quality indicators, an exploration of the barriers to and facilitating factors for their implementation among healthcare professionals and managers of intensive care units (ICUs) is advocated.
  
  
  METHODS
  All intensivists, ICU nurses, and managers (n = 142) working at 54 Dutch ICUs who participated in training sessions to support future implementation of quality indicators completed a questionnaire on perceived barriers and facilitators. Three types of barriers related to knowledge, attitude, and behaviour were assessed using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree).
  
  
  RESULTS
  Behaviour-related barriers such as time constraints were most prominent (Mean Score, MS = 3.21), followed by barriers related to knowledge and attitude (MS = 3.62; MS = 4.12, respectively). Type of profession, age, and type of hospital were related to knowledge and behaviour. The facilitating factor perceived as most important by intensivists was administrative support (MS = 4.3; p = 0.02); for nurses, it was education (MS = 4.0; p = 0.01), and for managers, it was receiving feedback (MS = 4.5; p = 0.001).
  
  
  CONCLUSIONS
  Our results demonstrate that healthcare professionals and managers are familiar with using quality indicators to improve care, and that they have positive attitudes towards the implementation of quality indicators. Despite these facts, it is necessary to lower the barriers related to behavioural factors. In addition, as the barriers and facilitating factors differ among professions, age groups, and settings, tailored strategies are needed to implement quality indicators in daily practice.
authors.affiliation: Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, PO Box 90153, Tilburg 5000 LE, the Netherlands. m.l.g.devos@uvt.nl.
authors.forename: Maartje Lg
authors.initials: ML
authors.lastname: de Vos
authors.forename: Sabine N
authors.initials: SN
authors.lastname: van der Veer
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Graafmans
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.forename: Peter Hj
authors.initials: PH
authors.lastname: van der Voort