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Table 3 Enablers: categories and properties

From: Developing and implementing a service charter for an integrated regional stroke service: an exploratory case study

1. Strategy and managerial commitment
A. Strategic alignment: The service charter fits the vision of all involved organizations and the goals of the chain.
B. A concrete and shared goal: There is a clear goal in using the service charter that is genuinely supported by all the organizations involved. It is to improve patient-centeredness and customer satisfaction.
C. Commitment and support: All the organizational boards fully understand the concept of a service charter, the consequences of using it and are committed to using it.
D. Resources: The involved organizations dedicate the appropriate people and other resources to the project.
2. Chain chemistry
A. Trust: Being open and transparent with each other and trusting in the other organizations that the initiative will be successful.
B. Willingness to cooperate: The commitment of all organizations to develop a single service charter for the whole chain. The capacity to listen to and to respect the opinions of the other organizations involved in the chain.
C. Chain before organization: Having the courage to prioritize the chain over the interests of the individual organization.
D. One organization in the lead: Having one organization in the lead in implementing the service charter and leading by example.
3. Chain characteristics
A. Structure of the chain: The number of organizations in the chain, the degree of competitiveness and the division of power within the chain. Plus, the way the chain has dedicated organizational units for stroke services in the involved organizations.
B. Extent of integration: The way processes in the chain are standardized and the chain works as a coordinated integrated care and patient journey.
C. Characteristics of patients: The age of patients, their diseases, their physical and emotional condition and the effects of these aspects on the way they want to be involved in the development of the service charter and are interested in using it.
4. Steering and managing the project
A. Project structure: Having a well-structured project structure and committees involving all participating organizations on the strategic, tactical and operational levels.
B. Steering Committee: Having a steering committee including members of all organizations with a broadand uniform mandate. This steers and systematically monitors progress in all phases of development using measures to realize the content of the charter and sustain the change.
C. Project leader: Having an independent, stimulating and active project leader in charge of the daily coordination of the project.
D. Support: Having experienced support from the project organization that infuses know-how and delivers supporting activities.
5. The way of development and implementation
A. Action plan: Having an action plan for all measures on both chain and organization levels.
B. Timing: Having the right timing: not so fast that commitment is not obtained, and not so slow that momentum is lost. Ensuring that all organizations work at the same pace.
C. Improvement actions: Investing the attention, time and energy to implement all the measures necessary to realize the content of the service charter in all organizations in a uniform manner.
D. Sustaining: Regularly and objectively measuring the structural realization of the content of the service charter on the chain and organizational levels.
E. Continuous improvement: Regularly evaluating and updating the service charter to match changing demands and preferences of patients. Taking corrective actions if necessary as part of the regular quality control of the chain.
6. Patient focus
A. Patient-focused service charter: The content of the service charter is based on needs and preferences of patients. Further, service standards are only promised that can be realized in practice. If standards are not met, there is compensation.
B. Patient research: The chain uses methods to research the needs and preferences of patients that give valid and reliable results for the entire patient group.
C. Patients understand the service charter: Using effective means to inform patients at the right moments about the philosophy and content of the service charter in order that patients fully understand and can use it.
D. Continuous feedback from patients: Using methods to obtain continuous patient feedback on the realization of the service standards.
7. Employee focus
A. Motivation and stimulation: Managers motivate and stimulate employees over the service charter.
B. Commitment of employees: Creating commitment in each employee to the goals and content of the service charter. Achieved by using the power of opinion leaders, involving all employees, creating a sense of urgency and defining a service charter that employees believe to be realizable.
C. Willingness to realize the service standards: There has to be a willingness to ensure the culture change necessary to achieve the patient focus. It is essential that each employee sees the promises in the service charter as his/her personal commitment/promise to each patient every day.