Every day, teams within the NHS strive to make things better, but individual, organisational and system-wide barriers get in the way. This evidence scan compiles published research about the key barriers to improvement in the NHS.

For this scan, 12 bibliographic databases were searched for published research available as of October 2014. Seventy-three studies about the NHS were analysed, as well as more than 100 studies from other countries as a comparison. Most studies in the NHS were small scale, based in a hospital context and published within the past five years. As such, further, larger-scale research would be useful.

The scan found that the top barriers to improvement in the NHS can be divided into those relating to:

  • the initiative itself, those relating to the skills and attitudes of individuals
  • organisational context
  • a broader system level.

These barriers are spread across the development, delivery and dissemination phases.

There were many similarities with international research but key areas where the NHS may differ include greater instability of organisational structures, less improvement experience among staff and fewer incentives to improve.

The report was produced as part of the Health Foundation’s work on the process of change and, in particular, to support the development of the report Constructive comfort: accelerating change in the NHS.

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