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Background We analyzed how a pain management program (PMP) in a cardiology department of a high-volume center was implemented into daily practice. The results provide some very valuable insights into the dynamics of complex professional behavioral changes, including the barriers to and facilitators of such changes. Methodology The behavioral dynamics during the implementation of the PMP were analyzed using normalization process theory (NPT) because NPT reflects both individual and collective contributions. NPT elements were then studied in their relation to social marketing tools, especially the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy. Where the EPOC tools did not wholly reflect the scope of the PMP, further marketing concepts were introduced. Results The frameworks used provided a useful structure to analyze the behavior change intervention, yielding insights into significant aspects of the change process (such as barriers and facilitators) at the level of the individual, within groups, and across the organization. By also integrating EPOC with NPT, we show how improvements in PMP tangibility can aid communication between PMP leaders and project participants. We also show how value can be co-created between the two groups. Conclusion Hospitals represent complex environments where effective behavior modification requires changes at many different levels. Nevertheless, we demonstrated, using NPT and the incorporation and adaptation of social marketing/EPOC tools, that an intervention designed to change behavior could succeed even in such extreme conditions.

Over 6 million people in Europe suffer from atrial fibrillation and this number is expected to double over the next 50 years. The main goal of atrial fibrillation therapy is the prophylaxis of thromboembolic complications. This is achieved by administering oral anticoagulation which is tailored to the patient’s individual risk profile (assessed with risk scores, such as the CHA2DS2-VASc score) and to the presence of comorbidities. Therapy is further tailored to the extent of patient symptoms. A frequency control of < 110 bpm seems to be sufficient. In highly symptomatic patients the current strategy for restoration of sinus rhythm is cardioversion, antiarrhythmic drug therapy and catheter ablation. Catheter ablation is increasingly being adopted as the first line therapy. Whether maintenance of the sinus rhythm can improve the prognosis of atrial fibrillation is currently the focus of atrial fibrillation research. © 2014, Springer-Verlag Berlin Heidelberg.