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Table 3 General barriers to and facilitators for implementing changes in palliative care

From: Barriers to and facilitators for implementing quality improvements in palliative care – results from a qualitative interview study in Norway

Theme

Subtheme

Barriers

Facilitators

Innovation

Credibility

• Tool not validated

• Pilot test tool

Advantages in practice

• Not apparent to staff

• Apparent to staff

Accessibility

• No storing system for paper copies

• Paper copies available

• Part of electronic documentation system

Responsibility

• One person responsible

• Sharing responsibility

Attractiveness

• Time consuming

• At odds with care philosophy

• Simplicity of tool

Individual professional

Motivation to change

• Innovation not perceived as attractive

• No regular training

• Not involved in planning

• Part-time/ temporary staff

• Innovation perceived as attractive

• Regular training

• Involved in planning

Knowledge and expertise

• Lack of PC expertise

• PC expertise

Confidence

• Lack of confidence

• Training in PC

• Access to advice from experts

Patient

Lack of compliance

• Lack of motivation

• Understate pain

• High symptom burden

• Reduced cognitive abilities

• Staff motivate patients

Social context

Leadership

• Distant management

• Lack of leadership support

• Nurses not represented in leadership group

• Negative attitude to change

• Enthusiastic

• Supportive

• Knowledge of implementation and organizational change

• Involve staff

• Tailor change

• Attentive

• Anchor change in administration

• Positive attitude to change

Culture of change

• Lack of support from colleagues

• Openness

Face-to-face contact

-

• Site visits and observation

• Joint educational sessions

Organizational context

Resources

• Low staff/patient ratio

• Lack of time

-

Structures and facilities

• Lack of facilities

• Changes in building structure

• Close proximity to collaborating services

• Flexible admission system

Expertise

• Lack of expertise

• Lack of QI nurse

• Previous experiences with improvement projects

• Low staff turnover

• QI nurse: PC + educational skills

Economic and political context

Policy and legislation’s influence on the level of expertise in community health care services

• Lack of PC resource persons

• Lack of educational training

• “Adopted” staff

-

Financial arrangements

• Lack of extra funding

• The coordination reform

• Extra state funding

• Hospital pays for medication

• National activity-based funding system

  1. PC palliative care, QI quality improvement