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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