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 âembedded it betterâ 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: âą Encouraged engagement âą Ensured follow through with outcomes âą Provided resources âą 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 âwas left do his job, the hospital would benefit but it doesnât have the resourcesâ. | ||
Team-Level Determinants | Structural characteristics | Team size | Workload: participant notes she had âno timeâ to prepare for the intervention, it âmakes up 0.001% of our workâ. | |
Team turnover/stability | ||||
Team workload | ||||
Teamwork | The quality of communication within the team and relationships amongst its members. | âUnless you approach {them} you would get no communication throughout the dayâ. | ||
Culture | The norms, values and assumptions of the team, the degree of autonomy given to staff and their perceptions of change. | âPut up and shut upâ mind set ââŠviews are valued, sought out in comparison to other multidisciplinary teams I would have been onâŠlike every member is valued and their input is welcomedâ. | ||
Compatibility | Does the intervention fit with existing workflows of the team? | Due to the âpressurisedâ nature of the ward environment (high patient turnover and poor staffing levels) the compatibility of intervention with the teamâs 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: âwe were short staffed, just couldnât get the timeâ. | ||
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 individualâs 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 interventionâs implementation considered a priority or an additional burden in daily practice? | The intervention is âa great way of stopping and reflectingâ. |