Table 1 Mapping of GPCC challenges and strategies against NPT constructs

Coherence

(sense-making work)

 (1) Differentiation

 (2) Communal specification

 (3) Individual specification

 (4) Internalization

Conflicting and/or divergent views and expectations about PCC

Translating abstract principles into concrete practices

Education and seminars organized by GPCC

Design of the training programme allowing for contextual adaptations and developments

Lunch seminars, informal meetings, inter-professional discussions in small groups

Invited lectures and seminars

Individual and/or collective ways of relating to professional experiences

Cognitive participation

(relational work)

 (1) Initiation

 (2) Enrolment

 (3) Legitimation

 (4) Activation

Resistance (to change)

Force of habit

Different approaches among professionals (mainly nurses and doctors)

Fatigue from previous implementations

Education and seminars organized by GPCC

Use of research-based evidence (e.g. reduced time of hospitalisation)

Using leading personalities, initiators (“ambassadors”), engaging previous personal relations at work

Convincing and motivating unwilling actors (e.g. doctors with “scientific” evidence)

Interpretation and collective development of routines (e.g. documentation)

Collective action

(operational work)

 (1) Interactional workability

 (2) Relational integration

 (3) Skill set workability

 (4) Contextual integration

Time shortage

Organizational problems (rotation of the staff and the physical environment)

Inter-professional hierarchies (mainly between nurses and doctors)

Different patient groups with specific conditions and needs

Division of workload (e.g. increased documentation)

Funding and extra staff (research nurses)

Initiating teamwork

Transfer of expertise via researchers and experienced implementers

Use of scales and technologies

Commitment and support of managers (e.g. initiating and consolidating teamwork)

Strengthening teamwork by engaging all expertise in the team (the patient included) and empowering nurses to contribute more to decision making

Developing new practices to safeguard continuity (e.g. introduction programmes for new staff

Reflexive monitoring

(appraisal work)

 (1) Systemization

 (2) Communal appraisal

 (3) Individual appraisal

 (4) Reconfiguration

Time shortage

Increased number of patients and more workload from documentation

Focus on shortening hospitalisation time

Small group discussions, “ethical forums”

Continuous education, evaluation in practice

Evaluation of the workload