Achieving and Resisting Change: Workarounds Straddling and Widening Gaps in Health Care

The international movement to reform health care and improve patient safety encompasses a range of strategies. These strategies include restructuring (Braithwaite et al 2005), policy reform measures (World Health Organization 2005; Garling 2008; National Health and Hospitals Reform Commission 2009; Hurst 2010) and programmes to standardise practice (Pronovost et al 2006; Gawande 2009; Iedema et al 2006). A social movement approach has been used to promote large scale change to the way in which patient safety is perceived and enacted within and across health services and systems (Bate et al 2004). Examples of this approach include international campaigns such as Five Moments for Hand Hygiene (World Health Organization 2006) and 5 Million Lives Campaign (McCannon et al 2007).