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Table 8 Initial Programme Theory

From: Application of the critical incident technique in refining a realist initial programme theory

CMOCContext+ Mechanism= OutcomeEvidence:
Key Informants
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 -trustThen 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