Article Text

Barriers and facilitators to change in the organisation and delivery of endoscopy services in England and Wales: a focus group study
  1. Frances Rapport1,
  2. Anne C Seagrove1,
  3. Hayley A Hutchings1,
  4. Ian T Russell1,
  5. Ivy Cheung1,
  6. John G Williams1,
  7. David Cohen2
  1. 1College of Medicine, Swansea University, Swansea, UK
  2. 2Health Economics Policy and Research Unit, Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, UK
  1. Correspondence to Dr Frances Rapport; f.l.rapport{at}


Objective Explore professional views of changes to gastroenterology service organisation and delivery and barriers and facilitators impacting on change. The work was undertaken as part of an evaluation in endoscopy service provision catalysed by the Modernising Endoscopy Services Programme of the Modernisation Agency.

Design Focus groups followed by analysis and group-working activities identifying key themes.

Setting English and Welsh secondary care gastroenterology units.

Participants 20 professionals working in gastroenterology in England and Wales. Medical, surgical and nursing specialists including endoscopy nurses. Opportunistic sampling to include senior people in leadership and management roles who were directly involved in service modernisation, excluding those involved in the Modernisation Endoscopy Services Programme.

Results Four 1.5 h focus groups took place in 2007. Summative and thematic analyses captured essential aspects of text and achieved consensus on key themes. 4 themes were revealed: ‘loss of personal autonomy and erosion of professionalism’, ‘lack of senior management understanding’, ‘barriers and facilitators to change’ and ‘differences between English and Welsh units’. Themes indicated that low staff morale, lack of funding and senior management support were barriers to effective change. Limitations to the study include the disproportionately low number of focus group attendees from English units and the time delay in reporting these findings.

Conclusions Despite ambitions to implement change, ineffective management support continued to hamper modernisation of service organisation and delivery. While the National Health Service Modernisation Agency Modernising Endoscopy Services Programme acted as a catalyst for change, affecting the way staff work, communicate and think, it was not effective in heralding change itself. However, gastroenterologists were keen to consider the potential for change and future service modernisation. The methodological framework of innovative qualitative enquiry offers comprehensive and rigorous enhancement of quantitative studies, including randomised trials, when a mixed methods approach is needed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Rapport F, Seagrove AC, Hutchings HA, et al. Barriers and facilitators to change in the organisation and delivery of endoscopy services in England and Wales: a focus group study. BMJ Open 2012;2:e001009. doi:10.1136/bmjopen-2012-001009

  • Contributors FR was the lead author and helped to run all the focus groups and analyse data ACS supported the focus group running and observed some of the focus groups. She also supported writing and reviewing the article. HAH was involved in designing the qualitative elements of ENIGMA and took a major role in reviewing drafts of this paper. ITR was the lead Trialist on ENIGMA and took part in the group work to analyse the qualitative data as well as supporting all written drafts and iterations of this paper. IC helped to design the qualitative element of the ENIGMA study, took part in analysing the qualitative data and input into all drafts of this paper. JGW designed ENIGMA, was the study's CI, supported the qualitative element of study development, took part in analysing the qualitative data and input into all drafts of this paper. DC was the lead health economist on ENIGMA. He helped develop the focus group sessions, input into group working underpinning data analysis and input into all drafts of this paper.

  • Funding This work was supported by the National Institute for Health Research Service Delivery and Organisation Programme grant number: SDO/46/2003.

  • Disclaimer the views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Wales Multicentre Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data from this qualitative study are available that are unpublished.