Famous Florentine writer, philosopher and historian Niccolò Machiavelli once said that, ‘there is nothing more difficult to carry out nor more doubtful of success nor more dangerous to handle, than to initiate a new order of things’ (Machiavelli, 1513). Putting research findings into practice has become increasingly recognised as a high priority among researchers and policy-makers (Foy et al, 2015); however, implementing change in organisations has historically been a complex and dynamic process that is not always successful. Balasubramanian et al (2015) suggested that change in healthcare is often focused on outcomes or targets, bypassing the educational aspect, and that individuals may be reluctant to amend their practice if they are unaware of the evidence that supports it.
Maternity services have seen several changes in recent years as a result of research findings or from the development of new technology, medicines and equipment. Significant national reviews of maternity services, such as Kirkup (2015), also have an effect on practice: often recommendations from these reviews are a high priority when it comes to making changes in maternity services, as evidenced by the publication of Better Births (National Maternity Review, 2016).
The Promoting Action on Research Implementation in Health Services (PARIHS) framework looks at the processes involved in implementing change based on research into practice (Rycroft-Malone, 2004), and proposes a 3-step approach of evidence, context and facilitation. Rycroft-Malone (2004) suggests that in order for change to be implemented, it needs to be based on a strong foundation of evidence, set within a clear context and supported by appropriate measures.
Barriers to change
One potential barrier is that individuals may not agree with proposed changes, and staff cope with this in their own ways. Depending on proposals, some staff may feel they are no longer in control or know what their future may hold. Some may feel they do not have the skills to manage the transition and may become uncomfortable when faced with new tasks because they do not know how to perform them (Iles, 2001). For new initiatives to be successful, barriers have to be identified and solutions put in place (1000 Lives Improvement, 2014). With the correct vision, skills, incentives, resources and action plans, change can be effective. If just one of those crucial factors is missing, it can be complex.
Longo (2011) highlighted the importance of communicating to staff the benefits of proposals. Good communication can aid the change process, as it may reduce some of the fears and questions staff may have, and staff are more likely to support and participate if they have a full understanding of what will happen.
Conclusion
Change is most successful when there is sufficient supporting evidence, which can help to reassure staff who are unsure. It is therefore the role of any midwife to ensure that their practice is based on the most recent evidence, to ensure care is clinically effective, safe and evidence-based (Nursing and Midwifery Council, 2015).