© 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 13 (2007) 287–294 287 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2006 The Authors; Journal compilation © 2006 Society/Blackwell Publishing Ltd200613287294Original Article Changing practice in Canadian NICUsB. Stevens et al . A qualitative examination of changing practice in Canadian neonatal intensive care units Bonnie Stevens RN PhD, 1,2 Shoo K. Lee MBBS FRCPC PhD, 3,4 Madelyn P. Law MA, 5 Janet Yamada RN MSc 6 and Canadian Neonatal Network EPIC Study Group 1 Professor, Faculties of Nursing and Medicine, University of Toronto, Toronto, ON, Canada 2 Signy Hildur Eaton Chair in Paediatric Nursing Research, Associate Chief of Nursing, Research, Sick Kids, Toronto, ON, Canada 3 Scientific Director for Integrated Centre for Care Advancement through Research (iCARE), Edmonton, Alberta, Canada 4 Professor of Pediatrics, University of Alberta, Edmonton, Alberta, Canada 5 Research Assistant, Faculty of Nursing, University of Toronto, Toronto, ON, Canada 6 Nursing Research Associate, Sick Kids Hospital, Toronto, ON, Canada Abstract Objective The goal was to explore the perspectives of health care professionals on factors that influence change to policies, protocols and practices in the Neonatal Intensive Care Unit (NICU) with regard to nosocomial infection and chronic lung disease. Study design An exploratory descriptive design using semi-structured individual and focus group interviews was used. Individual interviews ( n = 76) and focus group sessions ( n = 14 with a total of 78 participants) were conducted for a total of 154 health professional participants. Methods Mayring’s qualitative content analysis approach was used to analyse the data. All interviews were audio-taped, transcribed and analysed using inductive reasoning. The data were then organized into categories that reflected emerging themes. Results Seven categories that influenced practice change were derived from the data including staffing issues, consistency in practice, the approval process, a multidisciplinary approach to care, frequency and consistency of communication, rationale for change and the feedback process. These categories were further delineated into three emerging themes related to human resources, organizational structure and communications. Pettigrew’s conceptual framework provided a lens to view the results in relation to the process of change. Conclusions This study has helped to further our understanding of individual and organi- zational factors that facilitate and hinder changes in clinical practice in the NICU. These factors will be used as a starting point for organizational change to enhance infant out- comes in the NICU. Introduction There have been large practice variations reported in Neonatal Intensive Care Units (NICUs) across Canada [1] and the USA [2]. These variations have stimulated great interest from numer- ous stakeholders in neonatal outcomes. To achieve improve- ments in clinical and developmental outcomes for neonates, we must first understand the process of how proposed practice changes are embraced by health professionals within the NICU. The role of evidence, quality improvement efforts, and organiza- tional structure and culture are key elements in the change process. Review of the literature Evidence-based practice strategies for change in the NICU In the USA, there has been a coordinated programme to improve patient outcomes through the implementation of evidence-based practices. Through quality improvement projects, the Vermont Oxford Network has aimed to enhance the effectiveness and effi- ciency of care for infants in the NICU [2,3]. The research projects focused on four key habits for improvement: the habit for change, practice process, collaborative learning and evi- Keywords neonatal care, organizational change, quality improvement Correspondence Bonnie Stevens Faculties of Nursing and Medicine University of Toronto Signy Hildur Eaton Chair in Paediatric Nursing Research, Room 4734b Sick Kids, 555 University Avenue Toronto, ON M5G 1X8 Canada Accepted for publication: 30 October 2005 doi:10.1111/j.1365-2753.2006.00697.x