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Implementation of change in health care in Sweden: a qualitative study of professionals' change responses
Linköping University, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0002-0895-674x
County Council Östergötland, Sweden.
Linköping University, Sweden.
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 51Article in journal (Refereed) Published
Abstract [en]

Background: Implementation of evidence-based practices in health care implies change. Understanding health care professionals' change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals' responses to organizational and workplace changes that have affected their work. Methods: We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants' change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral. Results: Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework. Conclusions: We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 14, article id 51
Keywords [en]
Change response, Attitude, Health care, Implementation, Evidence-based practice
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-84522DOI: 10.1186/s13012-019-0902-6ISI: 000468112400001PubMedID: 31088483Scopus ID: 2-s2.0-85065737495OAI: oai:DiVA.org:lnu-84522DiVA, id: diva2:1320592
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-08-29Bibliographically approved

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Schildmeijer, Kristina

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