Theme | Subtheme | Barriers | Facilitators |
---|---|---|---|
Innovation | Credibility | • Tool not validated | • Pilot test tool |
Advantages in practice | • Not apparent to staff | • Apparent to staff | |
Accessibility | • No storing system for paper copies | • Paper copies available • Part of electronic documentation system | |
Responsibility | • One person responsible | • Sharing responsibility | |
Attractiveness | • Time consuming • At odds with care philosophy | • Simplicity of tool | |
Individual professional | Motivation to change | • Innovation not perceived as attractive • No regular training • Not involved in planning • Part-time/ temporary staff | • Innovation perceived as attractive • Regular training • Involved in planning |
Knowledge and expertise | • Lack of PC expertise | • PC expertise | |
Confidence | • Lack of confidence | • Training in PC • Access to advice from experts | |
Patient | Lack of compliance | • Lack of motivation • Understate pain • High symptom burden • Reduced cognitive abilities | • Staff motivate patients |
Social context | Leadership | • Distant management • Lack of leadership support • Nurses not represented in leadership group • Negative attitude to change | • Enthusiastic • Supportive • Knowledge of implementation and organizational change • Involve staff • Tailor change • Attentive • Anchor change in administration • Positive attitude to change |
Culture of change | • Lack of support from colleagues | • Openness | |
Face-to-face contact | - | • Site visits and observation • Joint educational sessions | |
Organizational context | Resources | • Low staff/patient ratio • Lack of time | - |
Structures and facilities | • Lack of facilities • Changes in building structure | • Close proximity to collaborating services • Flexible admission system | |
Expertise | • Lack of expertise • Lack of QI nurse | • Previous experiences with improvement projects • Low staff turnover • QI nurse: PC + educational skills | |
Economic and political context | Policy and legislation’s influence on the level of expertise in community health care services | • Lack of PC resource persons • Lack of educational training • “Adopted” staff | - |
Financial arrangements | • Lack of extra funding • The coordination reform | • Extra state funding • Hospital pays for medication • National activity-based funding system |