Table 8 Initial Programme Theory

1

Inter-disciplinary team approach and

Flattened hierarchy

If

Each team member’s voice is heard and considered of equal value

Then this enacts:

Understanding of roles, mutual respect, support and value

Self & team efficacy

Perception of shared decision making

Common purpose

resulting in:

Increased job satisfaction

Higher levels of competence

Better teamwork

Lower feelings of emotional exhaustion

Breaking down of inter-professional silos

More integrated care

Connectivity of the team and Camaraderie

and

More efficient use of time

KIs: 3,4, 5, 6, 9,11, 13,14, 15,17

2

Effective Communication

and Shared Understanding of Goals

If

There is clear, simple, open, honest and timely communication in an appropriate and inclusive environment with

SMART goal setting

Then this enacts:

Shared understanding and clarity of role and purpose;

Self- worth and value;

Perceptions of confidence and trust in the Intervention

resulting in:

Positive engagement of the team

Situational awareness

More integrated planning

More efficient use of time

and

Better chance of success

KIs: 1,3,4,5, 6, 9,10,11,12,

13,14,16,17

3

Leadership support and alignment of team goals with organisational goals

If

There is genuine leadership support in the form of tangible resources and positive acknowledgement of staff and alignment of team goals with organisational goals through effective engagement and dialogue

Then this:

Motivates, empowers and engages staff,

Enacts a sense of team efficacy; a perception of sense making and a shared sense of responsibility and accountability

resulting in:

Team pride and camaraderie; Connectedness and confidence in the broader system; Easier implementation and sustainability of the intervention

KIs: 1, 3, 4, 5, 6,7, 9, 10,11,12,13, 14,15

4

Characteristics of intervention that give credibility

If

The intervention is facilitated/ driven by experienced facilitators who staff can relate to and trust

With appropriate clinician involvement where relevant

And has perceived relevance to practice

with clearly defined goals/outcomes

Then this enacts:

Team pride and camaraderie;

Connectedness and confidence in the broader system;

Easier implementation and sustainability of the intervention

resulting in:

Team pride and camaraderie;

Connectedness and confidence in the broader system;

Easier implementation and sustainability of the intervention

KIs: 3,4,5,7,,9,11, 12,13,14,16,17

4a

Evidence, recognition and celebration of success

If

there is evidence of a positive outcome

and

When there is recognition and acknowledgement that an intervention is successful

Then this:

Empowers motivates and incentivises staff

resulting in:

Externally perceived credibility in the intervention and subsequent buy in

With increased likelihood of further engagement and spread of the intervention and/or future team interventions

KIs:3, 8,14

5

Appropriate Team composition and Physician engagement and support

If

there is broad and purposeful selection of team composition

with

• Physician engagement and support if intervention has a clinical focus

Then this enacts:

Feelings of knowledge confidence and competency

Psychological safety

and

Perception of power and influence

resulting in:

Legitimacy of the Intervention

Better and more timely “buy in”

Staff satisfaction

Translation of intervention outcomes to practice

and better chance of sustainability

KIs:1,2,3,4,5,6,7,8,9,10,11,12,13,14,15, 16,17

6

Personal Relationships

If

team members have positive personal relationships or prior experience of a positive working relationship and/or an established social network

Then this enacts:

Perceptions of Trust

Perceptions of Psychological Safety

Shared understanding of experiential knowledge of team: ways of working, skill-sets likes and dislikes

resulting in:

Better engagement in intervention and

Easier implementation

Ability to progress intervention issues informally

Distribution of work according to skill-sets

More honest and open communication

More integrated planning

Quicker recovery from conflicts

KIs:1,2,3,4,5,6, 7,9,11,13,14

7

Inter-professional tensions

If there are inter-professional tensions, rivalry and mis -trust

Then this enacts:

Feelings of frustration; lack of respect; dis-empowerment, perceptions of lack of psychological safety and cynicism

resulting in:

Failure to progress the intervention, lack of support for the intervention and/or withdrawal from the process

KIs:1,5,6,7,8,10,11,12

7a

Escalating mechanisms

If

There is failure to progress an intervention, lack of support for the intervention and/or withdrawal from the process because of inter-professional tensions

Then this enacts:

further escalating mechanisms of dis-satisfaction, depletion of energy and resilience and perception of powerlessness

resulting in:

Greater silo mentality among professions

KIs: 5,7,14