Gollop R, Whitby E, Buchanan D, Ketley D
Research into Practice Team, NHS Modernisation Agency, Leicester, UK.
Qual Saf Health Care. 2004 Apr;13(2):108-14. doi: 10.1136/qshc.2003.007450.
To explore scepticism and resistance towards changes in working practice designed to achieve service improvement. Two principal questions were studied: (1). why some people are sceptical or resistant towards improvement programmes and (2). what influences them to change their minds.
Semi-structured qualitative interviews were conducted with 19 clinicians and 19 managers who held national and regional roles in two national programmes of service improvement within the NHS involving systematic organisational changes in working practices: the National Booking Programme and the Cancer Services Collaborative (now the Cancer Services Collaborative Improvement Partnership).
Scepticism and resistance exist in all staff groups, especially among medical staff. Reasons include personal reluctance to change, misunderstanding of the aims of improvement programmes, and a dislike of the methods by which programmes have been promoted. Sceptical staff can be influenced to become involved in improvement, but this usually takes time. Newly won support may be fragile, requiring ongoing evidence of benefits to be maintained.
The support of health service staff, particularly doctors, is crucial to the spread and sustainability of the modernisation agenda. Scepticism and resistance are seen to hamper progress. Leaders of improvement initiatives need to recognise the impact of scepticism and resistance, and to consider ways in which staff can become positively engaged in change.
探讨对旨在改善服务的工作实践变革的怀疑态度和抵触情绪。研究了两个主要问题：（1）为什么有些人对改善计划持怀疑或抵触态度；（2）是什么影响他们改变想法。
对19名临床医生和19名管理人员进行了半结构化定性访谈，他们在国民健康服务体系（NHS）的两个全国性服务改善计划中担任国家和地区职务，这两个计划涉及工作实践中的系统性组织变革：国家预约计划和癌症服务协作组织（现为癌症服务协作改善伙伴关系）。
所有员工群体中都存在怀疑和抵触情绪，尤其是医务人员。原因包括个人不愿改变、对改善计划目标的误解以及对计划推广方式的反感。持怀疑态度的员工可以被影响而参与到改善中来，但这通常需要时间。新获得的支持可能很脆弱，需要持续有好处的证据来维持。
卫生服务人员，特别是医生的支持，对于现代化议程的推广和可持续性至关重要。怀疑和抵触被视为阻碍进步。改善举措的领导者需要认识到怀疑和抵触的影响，并考虑如何让员工积极参与变革。
