Table 5.

Barriers

Barriers		Impact of Barriers
Time constraints	N = 26; 66%	Changed timeline	N = 12; 31%
Costs	N = 18; 47%	Provided training	N = 8; 21%
Equipment problems	N = 11; 29%	Changed staffing	N = 5; 13%
Lack of properly trained/motivated staff	N = 10; 26%	Brought in external consultants	N = 2; 5%
Took more time than expected	N = 9; 24%	Changed systems/processes	N = 2; 5%
Lack of financial incentives	N = 8; 21%	Increased budget	N = 1; 3%
Resistance of clinical staff	N = 7; 18%	Changed leadership	N = 0
Staff turnover	N = 5; 13%
Process more difficult than expected	N = 4; 10%
Conflicting pressures from others	N = 4; 10%
Used more resources than expected	N = 3; 8%
Incompatible systems/processes	N = 3; 8%
Evaluation of results	N = 2; 5%
Tracking implementation	N = 2; 5%
Lacked information on process	N = 1; 3%
Lack of nonfinancial rewards	N = 1; 3%

Factors cited as barriers to performance measurement and quality improvement, reported in percentages of physicians who reported them.