Table 2 Extracted quotations illustrating barriers to change

Lack of trust and poor relationships between primary care and decision-makers

“Participants pointed to concerns regarding who was having conversations with whom, and the historical mistrust between professionals and health authorities.” [13].

“Regional actors had kept the frontline out of the early stages of network consultations [and] many community actors still considered the omission of frontline personnel from planning and partnering efforts as a clear indication that the initiative was, ultimately, a “top-down” undertaking.” [14].

“One of the major challenges to integrate care vertically or ‘knitting’ the locally-based primary care plan with regional plans… is the lack of knowledge and expertise in the field of primary care at the [sustainability and transformation partnerships] level.” [18].

Strong professional physician identity

“Directives from ‘above’ to make changes in these daily routines are expected to face resentment and resistance. When considered in connection with ideas of professional autonomy and the sanctity of clinical judgment, frontline personnel and their cultures of practice present potentially substantial barriers to the implementation of these reforms.” [14].

“I think there’s a cohort of people who see it as an opportunity to shape the future and then there’s a cohort of people who think, you know, it’s concerning about the future of general practice.” [18].

“Physicians said that they listened carefully to the [Alberta Medical Association’s] concerns, and they were more leery of full participation in the [Primary Care Network] as a result.” [19].

Clinically irrelevant and complex proposals for change

“Identified barriers to engagement of primary care physicians include limited time and resources, lack of information technology and staff support, and the perception that proposed interventions are either irrelevant or impractical to day-today practice.” [20].

“The slow, bureaucratic nature of decision-making bred frustration and alienation; and the loose, conceptual definition of [My Health Teams] was a source of confusion and even some suspicion.” [21]

Lack of capacity and supports

“Participants cited limited time, capacity, or resources to develop new work or new partnerships in the face of struggling to just “keep the lights on” for current services.” [15].