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Table 2 Context Coding Framework

From: Development of an integrative coding framework for evaluating context within implementation science

System Level

Characteristic

Definition

Example

System-Level Determinants

Social Environment

Cosmopolitanism

How connected the hospital is with external organisations/events and the impact of this network?

View that being affiliated with a hospital group (hospitals in Ireland organised into seven hospital groups) provides more learning opportunities for staff.

Peer Pressure

Mimetic or competitive pressure to implement an intervention.

A team member asks researchers if other teams have “embedded it better” and how this was achieved.

Political Environment

External Incentives and Influence

External incentives to spread the uptake of interventions (national policy, guidelines, collaborations), external influence regarding decision making (e.g. external change agents).

Perceived threat following a proposed systems change leaving staff anxious about future prospects.

Economic Environment

External economic factors within the wider health system which may influence the capacity and resources available to the setting.

Disparity in funding. Hospitals, comparable in size and characteristics acknowledged as receiving greater resources due to previously publicised incidents.

Organisational-Level Determinants

Structural characteristics

Hospital Classification

Participants confirm an increased demand on the hospital, with the number of patients on trolleys exceeding the norm.

Hospital size

Hospital workload

Networks and communications

The quality of communication within the organisation and relationships amongst its members.

National survey data highlight strong relationships among staff, however, relationships between management and frontline appear taut.

Culture

The norms, values and assumptions of the organisation, the degree of autonomy given to staff and their perceptions of change.

Hospital documents suggest a culture characterised by openness, trust and inclusion.

Compatibility

Is there a tangible fit between the values and norms of the organisation to the intervention?

The collective leadership intervention appears to align with the open culture outlined in hospital reports.

Organisational support

Is organisational support evident? Are rewards offered by the organisation for engagement with the intervention?

Food provided by the organisation at each session and is suggested to enhance staff attendance.

Organisational climate

Staff perceptions of and emotional responses to the characteristics of their organisation including attitudes towards learning.

One team member discusses the importance of valuing staff by supporting their educational needs.

Organisational leadership engagement

Are organisational leaders/managers (e.g. CEOs, executive members) committed/to the implementation effort?

Senior managers:

‱ Encouraged engagement

‱ Ensured follow through with outcomes

‱ Provided resources

‱ Organised implementation

Available resources

The level of resources available within the organisation to complete the intervention including human (e.g. appropriate staffing levels), financial and technological resources.

Noted that if one team member “was left do his job, the hospital would benefit but it doesn’t have the resources”.

Team-Level Determinants

Structural characteristics

Team size

Workload: participant notes she had “no time” to prepare for the intervention, it “makes up 0.001% of our work”.

Team turnover/stability

Team workload

Teamwork

The quality of communication within the team and relationships amongst its members.

“Unless you approach {them} you would get no communication throughout the day”.

Culture

The norms, values and assumptions of the team, the degree of autonomy given to staff and their perceptions of change.

“Put up and shut up” mind set

“
views are valued, sought out in comparison to other multidisciplinary teams I would have been on
like every member is valued and their input is welcomed”.

Compatibility

Does the intervention fit with existing workflows of the team?

Due to the “pressurised” nature of the ward environment (high patient turnover and poor staffing levels) the compatibility of intervention with the team’s current workload is questionable.

Available resources

The level of resources available to complete the intervention within the team including human (e.g. appropriate staffing levels), financial and technological resources.

Inadequate staffing impeded staff engagement with the intervention: “we were short staffed, just couldn’t get the time”.

Local leadership engagement

Are frontline leaders/managers (e.g. consultants, clinical nurse managers) committed and involved in the implementation? Are peer leaders evident?

One senior team member asks to take intervention materials to use with junior doctors at another education session.

Team efficacy

Does the team believe in their skills and capabilities to implement the intervention successfully?

The team raise concerns regarding lack of training and skills to achieve their developed goals.

Individual-Level Determinants

Self -efficacy

An individual’s belief in their capabilities to implement the intervention and manage its outputs.

One team member indicates that he is capable to contribute more to the team, but his job role does not allow this.

Individual attitudes

Participants perceptions of the advantage and relevance of the intervention. Is the intervention’s implementation considered a priority or an additional burden in daily practice?

The intervention is “a great way of stopping and reflecting”.