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Effective Implementation Strategies and Tactics for Leading Change on Maternity Units

Bingham, Debra DrPH, RN; Main, Elliott K. MD

The Journal of Perinatal & Neonatal Nursing: January-March 2010 - Volume 24 - Issue 1 - p 32–42
doi: 10.1097/JPN.0b013e3181c94a24
Feature Articles

Change implementation within organizations is a complex and dynamic process that is not always successful. Tailoring the implementation strategies and tactics to address the identified barriers to change is one method that has been shown to be effective. Examples of 3 broad types of interrelated strategies used by frontline leaders when implementing quality improvement (QI) projects are (1) discourse (communication), (2) education (formal and informal), and (3) data (audit). Examples of common barriers to implementation are leaders' and clinicians' knowledge, attitudes, and practices, the QI topic characteristics, and the implementation climate. External pressures from national organizations such as the National Quality Forum, the Leapfrog Group, and The Joint Commission likely facilitate change. Knowledgeable, tenacious, and creative frontline physician and nurse leaders may have the greatest impact on QI implementation effectiveness because they are the individuals who decide how the strategies and tactics will be tailored.

California Maternal Quality Care Collaborative, Stanford University, Palo Alto (Drs Bingham and Main); and California Pacific Medical Center, San Francisco (Dr Main).

Corresponding Author: Debra Bingham, DrPH, RN, California Maternal Quality Care Collaborative, Medical School Office Building, 251 Campus Dr, Stanford University, Palo Alto, CA 94305 (

Submitted for publication: July 26, 2009

Accepted for publication: November 4, 2009

© 2010 Lippincott Williams & Wilkins, Inc.