142 Chapter 18 Change is not made without inconvenience, even from worse to better. Richard Hooker, 1554–1600 Changing established behaviour of any kind is diicult. It is particularly challenging in complex critical healthcare settings because of the varied relationships between a wide range of organisations, professionals, patients, and carers. Barriers to change can take a long time to overcome when discussing guidance for implementation in clinical practice; a clinical guideline can take up to 3–5 years to be fully implemented. One may need to consider the scale of change that can be achieved realistically when seeking to implement behavioural change in intensive care units (ICUs); even small changes require trust-building measures and can have a positive impact, especially if the change involves an action that is repeated oten. Certain trust-building factors may help to foster an environment that is conducive to behaviour change. An organisation where there is strong leadership, authentic communica- tion, and transparent governance has a much greater chance for success. No matter how nec- essary change seems to upper management, the barriers must be authentically acknowledged and not swept under the carpet if a strategic change is to be implemented successfully. he key to successful change is in the planning, messaging, and implementation. However, barriers to changing established practice may prevent or impede progress in all organisations, whatever the culture. he three greatest barriers to organisational change are most oten the following: inadequate culture-shit planning, lack of employee involvement, lawed communication and leadership strategies. Organisations also need a clear system in place to support ongoing measurement, implemen- tation, and assessment, and efective ways to address the normalised deviance. his chapter aims to provide practical advice to intensive care providers and administrators on how to encourage and support healthcare professionals and managers to change their clinical practices. Complications in critical care Patient safety and patient-centred care are emerging as key drivers in healthcare reform. hings have changed but oten as a by-product of inancial reform. Belatedly, safety and qual- ity benchmarks are being integrated into all healthcare organisations’ strategic goals. here is Addressing barriers for change in clinical practice Paul R. Barach Quality Management in Intensive Care, ed. Bertrand Guidet, Andreas Valentin and Hans Flaatten. Published by Cambridge University Press. © Cambridge University Press 2016.