Australian midwives' experiences of implementing practice change.

OBJECTIVE: The introduction of the best available evidence into health care practice is a complicated and uncertain process. Attempts to translate even highly reliable evidence into care provision are known to flounder. The objective of this study was to investigate midwives' experiences of leading practice change. DESIGN: This study was conducted using Glaserian Grounded Theory methodology. SETTING: Australian midwifery practice contexts provided the setting for this study. PARTICIPANTS: Midwives who had led practice change initiatives. FINDINGS: Sixteen Australian midwife change leaders participated in this study. Each had sought to implement a workplace practice change. The core problem experienced by the participants was labelled 'So many barriers on so many levels'. KEY CONCLUSIONS: Although some participants were encouraged, supported and enabled to enact change to some degree, even when the change was initiated by the practice site, all participants experienced a number of obstacles at many levels in their implementation efforts. For most, this meant that their endeavours to move the best available evidence into practice took many years or did not progress at all. IMPLICATIONS FOR PRACTICE: The findings of this study will be of interest to midwives, midwifery leaders and midwifery educators. Understanding the factors in midwifery care environments that support or limit the uptake of best evidence into practice will help to inform and develop midwifery context-specific mechanisms to expedite sustained practice innovation.