BARRIER IDENTIFICATION AND MITIGATION

Instructions:. Use the Barrier Identification and Mitigation Tool template to collect information on potential barriers to evidence based practice change. Identify barriers by observing practice, discussing recommended practice with staff, and simulating or trying to conform to recommended practices (walk it, talk it, trying it).
Step 1:  Walk it, talk it, try it.

Observe the current practice (walk it). Look for:

·         Steps skipped

·         Work-arounds (other process steps)

·         Why it is difficult to comply (i.e. barriers)

·         Factors that support compliance (i.e. facilitators)

Ask people about the current practice (talk it). Ask if:

·         Staff are aware of the evidence

·         Staff agree with the evidence (i.e. Do staff think it’s appropriate for their patients?)

·         Staff have any suggestions to improve compliance with the evidence

Attempt the Process (try it). See if:

·         You can comply with the practice change using simulation or, if appropriate, under real world circumstances.

Continue collecting data until no new barriers are identified and a comprehensive understanding of current practices achieved.

Step 2: Summarise the barriers and remove any duplicates

Step 3: Identify mitigation strategies for each of the identified barriers
Prompt questions Barriers Potential mitigating actions
Barriers related to the provider
Knowledge of recommended practice: Do they know what is recommended practice?
Attitude regarding recommended practice: What do they think about the practice change?
Current practice habits:  What do they currently do (or not do)?
Perceived compliance with the evidence: How often do they comply with recommended practice?
Barriers related to the evidence based practice change
Applicability to patient population: How often does the practice change apply?
Evidence supporting the practice change: How strongly does the evidence support the change?
Ease of complying with evidence based practice change: How does the practice change impact the workload?  

 
Barriers related to the system
Task: Who is responsible for each recommendation?
Tools & technologies: Are necessary supplies and equipment available and used appropriately?
Decision support (e.g. checklists, care plans): How often are aids available and used?
Physical environment: How does the unit’s layout affect compliance?
Organisational structure (e.g. staffing, policies): How does the organisational structure influence compliance?
Management support: How does management visibly (and substantially) influence compliance with recommended practice?
Unit culture: How does the unit culture influence compliance?