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Table 6 Context coding framework pre-implementation: Culture (Case A)

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

System Level

Characteristic

Site Description

Construct Rating

Organisational-Level Determinants

Culture:

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

‱ Hospital reports suggests a culture characterised by openness, trust, and inclusion

+ 2

Construct has a positive effect that may facilitate implementation

Team-Level Determinants

Culture:

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

‱ Survey data suggests that there is a hierarchical culture within the team in which staff sometimes feel unheard, unable to speak up, and isolated. 16% also agreed that they feel intimidated by team members' behavior

‱ Interview data also highlights a hierarchical culture:

 ◩ Control- “the consultants are in charge, what they say goes, the consultants make demands”-some noted to “push the boundaries”

 ◩ Silo working- “We’re just so individual
it is quite siloed”, “Everyone just kind of looks after themselves”

 ◩ Staff “afraid to open your mouth” to a senior member of staff, this “fear factor” is recognised as impacting the reporting culture within the team

 ◩ Suggested that senior doctors are “dismissive of any other disciplines”, “never ask my opinion”

‱ Despite the hierarchy discussed by most participants, some team members are “satisfied” with the team and feel that “everyone is listened to”

−2

Construct has a negative effect and may impede implementation