Checkland Kath, Harrison Stephen, Marshall Martin
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
J Health Serv Res Policy. 2007 Apr;12(2):95-100. doi: 10.1258/135581907780279657.
To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this.
Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England.
The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves.
The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.
调查英国的普通医疗实践如何应对官僚主义举措，如国民健康服务（NHS）的国家服务框架（NSFs），并探讨“变革障碍”这一比喻对于理解这一情况的价值。
对英格兰北部四家医疗机构进行案例研究，采用访谈、非参与观察和文献分析。
这些医疗机构并未积极实施国家服务框架。在访谈中，列出了各种阻碍实施的“障碍”，包括文件的复杂性和时间不足。观察表明，这些障碍是参与者用来理解自身所处情况的一种建构。
在政策未实施是潜在组织现实的一种突发属性的背景下，“消除变革障碍”这一比喻的作用有限，只有解决这些现实情况，才可能对其进行改变。
