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CPSI Share                                                  
6/20/2019 9:00 AM

By Julia E. Moore, The Center for Implementation

Have you finished a change project and realized you did not achieve the outcomes you were hoping for? Did you encounter unexpected barriers that prevented you from making real progress? All implementation efforts are fraught with these very real and important challenges.

Implementers often look back and question what went right and what went wrong in their change initiatives. Imagine the impact you could have if, instead of exploring this retroactively, you were able to anticipate barriers and facilitators in advance. You could address the barriers and leverage the facilitators, thus increasing your chance for success.

You can have a greater impact when you leverage the science of implementation to inform how you understand barriers and facilitators to change. Luckily the best practices from implementation science are complementary with quality improvement (QI), so if you've been trained in QI, implementation science can supplement rather than replace your current approach.1

In the "plan" stage of your Plan-Do-Study-Act (PDSA), you can embed a barriers and facilitators assessment to explore what might be a hindrance to, or what can be leveraged for, change. You can use a theory of change to understand why these barriers and facilitators are important, and how they impact change. For example, the capability, opportunity, motivation – behaviour (COM-B) theory2 is a great way to better understand why people do and don't change. Essentially, this theory states that in order to change, a person needs three things:

  • to be capable of changing (i.e., have the knowledge and skills to change),
  • have the opportunity to change (i.e., an environment that supports change), and
  • be motivated to change (i.e., belief in their responsibility to change and intent to change). 
In healthcare, we spend a lot of time educating and training – essentially providing people with knowledge and skills (capability). We are increasingly focusing on how an environment can support change (opportunity). But, if we do not also address people's underlying motivation to change, our change efforts will never create the long-term impact we aspire to achieve. When interacting with individuals who are expected to change, consider whether their reluctance to change is driven by a lack of knowledge/skills, insufficient opportunity, or their underlying motivation. This information will guide you in tailoring your change efforts to address the root causes of the barriers and facilitators you have identified, and to be more proactive in doing so.

When you anticipate barriers and facilitators to success you can address the barriers and leverage the facilitators. You can see issues that need to be addressed before they get out of control. Imagine the impact you could have.

Good luck!

Julia E. Moore is the Senior Director at the Center for Implementation and has a PhD in Human Development from Penn State. She has supported over 75 change initiatives and trained over 1,500 people to apply implementation science. To learn more about how you can create change and achieve the impact you are looking for, check out the Center for Implementation's monthly Implementation in Action bulletin or sign up for a free online mini-course.


  1. Koczwara, B., Stover, A.M., Davies, L., et al. (2018). Harnessing the synergy between improvement science and implementation science in cancer: A call to action. Journal of Oncology Practice, 14(6), 335-340.

  2. Michie, S., van Stralen, M.M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behavior change interventions. Implementation Science, 6(42), 1-11.