Understanding the challenges of service change – learning from acute pain services in the UK

SummaryObjectivesTo explore organizational difficulties faced when implementing national policy recommendations in local contexts.DesignQualitative case study involving semi-structured interviews with health professionals and managers working in and around acute pain services.SettingThree UK acute hospital organizations.Main outcome measuresIdentification of the content, context and process factors impacting on the implementation of the national policy recommendations on acute pain services; insights into and deeper understanding of the generic obstacles to change facing service improvements.ResultsThe process of implementing policy recommendations and improving services in each of the three organizations was undermined by multiple factors relating to: doubts and disagreements about the nature of the change; challenging local organizational contexts; and the beliefs, attitudes and responses of health professionals and managers. The impact of these factors was compounded by the interaction between them.Con...