title: Improving the organization of palliative care: identification of barriers and facilitators in five European countries.
abstract: BACKGROUND
  Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care's complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service.
  
  
  METHODS
  Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data.
  
  
  RESULTS
  Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries.
  
  
  CONCLUSIONS
  This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.
authors: Jasper
authors: J
authors: van Riet Paap
authors: Myrra
authors: M
authors: Vernooij-Dassen
authors: Frederike
authors: F
authors: Brouwer
authors: Franka
authors: F
authors: Meiland
authors: Steve
authors: S
authors: Iliffe
authors: Nathan
authors: N
authors: Davies
authors: Wojciech
authors: W
authors: Leppert
authors: Birgit
authors: B
authors: Jaspers
authors: Elena
authors: E
authors: Mariani
authors: Ragni
authors: R
authors: Sommerbakk
authors: Kris
authors: K
authors: Vissers
authors: Yvonne
authors: Y
authors: Engels
mesh_terms: D003431:Cross-Cultural Comparison; D004739:England / Q000453:epidemiology; D017144:Focus Groups; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D009936:Organizational Innovation; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards* / Q000639:trends; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards