Article Text

Download PDFPDF
Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors’ and managers’ views
  1. R Gollop1,
  2. E Whitby1,
  3. D Buchanan2,
  4. D Ketley1
  1. 1Research into Practice Team, NHS Modernisation Agency, Leicester, UK
  2. 2Leicester Business School, De Montfort University, Leicester, UK
  1. Correspondence to:
 R Gollop
 Research into Practice Team, NHS Modernisation Agency, St John’s House, East Street, Leicester LE1 6NB, UK;


Objective: To explore scepticism and resistance towards changes in working practice designed to achieve service improvement. Two principal questions were studied: (1) why some people are sceptical or resistant towards improvement programmes and (2) what influences them to change their minds.

Methods: Semi-structured qualitative interviews were conducted with 19 clinicians and 19 managers who held national and regional roles in two national programmes of service improvement within the NHS involving systematic organisational changes in working practices: the National Booking Programme and the Cancer Services Collaborative (now the Cancer Services Collaborative Improvement Partnership).

Results: Scepticism and resistance exist in all staff groups, especially among medical staff. Reasons include personal reluctance to change, misunderstanding of the aims of improvement programmes, and a dislike of the methods by which programmes have been promoted. Sceptical staff can be influenced to become involved in improvement, but this usually takes time. Newly won support may be fragile, requiring ongoing evidence of benefits to be maintained.

Conclusions: The support of health service staff, particularly doctors, is crucial to the spread and sustainability of the modernisation agenda. Scepticism and resistance are seen to hamper progress. Leaders of improvement initiatives need to recognise the impact of scepticism and resistance, and to consider ways in which staff can become positively engaged in change.

  • quality improvement
  • change management
  • scepticism
  • resistance

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • * One clinician was interviewed twice, once in each group.

  • Conflicts of interest: none.

Linked Articles

  • Quality lines
    BMJ Publishing Group Ltd