Table 1.

The “3 + 3 Decision Framework”

The 3 + 3 Decision Framework: sources of resistance to change
Structural resistance group	Contextual resistance group
1. The dysfunctional characteristics found in most organizations	1. The inherent complexity of delivering high quality, safe, and affordable modern inpatient care in a hospital setting
2. The particular dysfunctions of professional health sector organizations	2. A set of specific market failures in public hospitals, which limit the scope of the standard financial incentives and reform measures
3. The additional dysfunctional dimensions of politically managed organizations	3. The unique problem of generalized and localized anxiety, which accompanies the delivery of medical services, and which suffuses decision-making on the part of patients, medical staff, hospital management, and political actors alike

Source: Summarised from Edwards and Saltman [10]