Implementing on a Unit With No Infrastructure

In practice

The change is agreed and nothing happens. Appraisal is not implementation, and this is where the gap opens. Assessment comes before any plan. Culture is the shared belief that evidence governs practice; readiness is whether this unit can act on it now; infrastructure is what makes acting possible — time, access, mentors, and a route by which a clinician's question reaches someone who can answer it. This unit has the first, some of the second, and none of the third. The barriers are named specifically rather than as resistance: no protected time, no database access at the point of care, no mentor, and no consequence attached to whether the schedule is followed. Competence without infrastructure is squandered, which is why sending three nurses on a course would spend the budget and change nothing. So the infrastructure is built concurrently rather than afterwards. A mentor is identified on the unit rather than imported. Access is arranged. The schedule is written into the documentation flow so that following it is the path of least resistance. Accountability is assigned to a person rather than to the unit. Only then is the change introduced, and it is introduced to a unit that can now carry it rather than to one that will be blamed when it does not.