Implementation of evidence-based practices in health care implies change. Understanding health care professionals’ change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals’ responses to organizational and workplace changes that have affected their work. We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants’ change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral. Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework. We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

中文翻译：

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瑞典医疗保健变革的实施：专业人员变革反应的定性研究

在医疗保健领域实施循证实践意味着变革。了解医疗保健专业人员的变革响应可能对于促进在快速变化的医疗保健环境中实现循证实践至关重要。本研究的目的是调查医疗保健专业人员对影响其工作的组织和工作场所变化的反应。我们对瑞典医疗保健系统雇用的 30 名医疗保健专业人员（医生、注册护士和助理护士）进行了采访。采用归纳法，使用作者开发的半结构化访谈指南。我们使用 1999 年首次发布的分析框架来分析信息提供者的变革响应，其中变革响应被视为从强烈接受变革到强烈抵制变革的连续体，描述了沿着该连续体的七种形式的变革响应。变革响应被概念化为由三个组成部分组成的三维态度：认知、情感和意图/行为。对数据的分析产生了 10 种类型的变革响应，可以将其映射到框架中 7 个变革响应类别中的 5 个。参与者没有报告与框架中两种最极端的反应形式（即承诺和积极抵抗）相对应的变革反应。大多数变革反应被归类为冷漠或消极抵制变革。当医疗保健专业人员自己发起变革时，或者当变革体现了他们的积极投入时，以及当变革被认为有充分依据和良好沟通时，就会参与或支持变革。我们没有发现任何无法融入该框架的变革响应。我们发现该框架有助于细致地了解人们如何应对变化。这种关于变革响应的知识对于变革的管理以及在医疗保健领域更成功地实施循证实践的努力很有用。