Barriers and possible solutions

Implementing a change in a clinical practice or process often requires overcoming certain barriers or challenges. This section describes several common barriers encountered by other hospitals when instituting changes related to the insertion and care of indwelling urinary catheters as well as the strategies they used to overcome those barriers.  

While the situation may not be exactly the same at your hospital, both the barriers described and the suggestions provided may be helpful in identifying potential solutions when challenges arise or for anticipating issues that may need to be addressed.

The literature on implementing evidence-based practices and practice guidelines may also provide valuable guidance. For example, Francke and colleagues (2008) examined 12 systematic reviews and identified the following categories as influencing guideline adherence: guideline characteristics, implementation strategies, professional autonomy, and patient and environment characteristics. In addition, De Vos et al. (2009) reviewed 21 studies and identified perceived barriers for quality initiatives including unawareness, lack of credible data, lack of management support for physicians, and lack of resources. Facilitating factors included supportive or collaborative management, administration support, and use of detailed and credible feedback data.

Lastly, theoretical perspectives may also be valuable in implementing evidence-based practice and practice guidelines (Gurses 2010, Grol and Wensing 2004). Some of the useful frameworks are:

  • The theories of diffusion of innovationcomplex adaptive systems, and planned behavior,
  • The PRECEDE-PROCEED (Predisposing, Reinforcing, and Enabling Constructs in Ecosystem Diagnosis and Evaluation for Policy, Regulation or Resourcing, and Organizing for Educational and Environmental Development) model, 
  • The TRIP (Translating Research Into Practice) model,
  • The RE-AIM model (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) model,
  • The PRISM (Practical, Robust Implementation and Sustainability Model) model, and
  • The PARIHS (Promoting Action on Research Implementation in Health Services) model, and 
  • The CFIR (Consolidated Framework For Implementation Research) model.