So I just started my first job at medium sized trauma center. Its an ACT practice but the relationship with the MDA's is pretty collegial and they mostly let you do what you want. Unfortunately, there are a few things I've noticed so far that are more or less off limits for what I think are pretty marginal reasons (ie, personal preference or unwillingness to try something new). There are a couple of things that I think would have a positive & cost-effective impact for our patients, stuff I saw over and over again in a wide variety of practice settings in school that definitely improved patient care.

For those of you that have tried, successfully or not, to introduce a change in institutional practice - what did you do right, what did you do wrong and what advice could you give me in making the case for these changes?