There has been a strong emphasis on effective pain management in recent yea
rs, yet application of new knowledge and research in the area seems to be i
mplemented inadequately. Traditional educational approaches for clinicians
must be complemented by interventions in health care systems that more dire
ctly influence the routine behaviors of clinicians, In an effort to address
this problem, a project was designed to increase institutional commitment
to improving pain management in two rural hospitals. The purpose of this ar
ticle is to present the change process used and the findings from the progr
am.