Table 1 Progressively identified and targeted barriers related to the OR context, and their linkages to theory-based strategies, proposed mechanisms of action, and the intervention activities
| Targeted barriers | Theory-based KT strategy | Proposed mechanisms of action | KT activities |
|---|---|---|---|
| Lack of teamwork, trust, and communication | Interprofessional learning [66] and dialogue within a safe learning “container” [45] |
Increased levels of interaction Strengthened relations Improved understandings between professionals groups and managers | Facilitating regular dialogue meetings between a selected group of professionals and managers (the Learning Lab group) |
| Lack of knowledge regarding HAI, patient outcome and HH performance |
Audit and feedback [60] Education based on adult learning theory [67], situated and experiential learning [68, 69] |
Increased motivation and commitment Internal drive for seeking knowledge and change |
Visualization of patient outcome data and behavioral feedback Mindful observations of one’s own and one’s peers’ HH practice Facilitated problem-based learning Co-creation of printed information material Reviewing “My five moments for hand hygiene” |
| Skepticism about the value of HH and AT |
“Celebrating” resistance Challenging basic assumptions [46] |
Decreased skepticism about the evidence in support of HH and AT Increased commitment to change |
Workshop welcome and encouraging participants’ diverse perspectives Facilitators actively seek to understand and address hesitation, questions and resistance in a respectful way Reviewing the evidence for HH and AT in relation to invasive procedures Co-producing printed evidence-based information on HH |
| Lack of tailoring of the clinical guidelines to the OR context | Co-creation [70, 71] and design thinking [72] | Relevant and meaningful HH and AT routines |
Step 1: Welcome and promote innovative new ideas; sense, probe, respond and reflect in an iterative process in the Learning Lab group Step 2: Involve OR staff in the testing, reflection and refining of standardized operational procedures |
| Lack of role models and opinion leaders | Using facilitators [27] with social impact [28] | Role modeling from credible and trusted sources |
Strive to create honest relationships between facilitators and participants Lab participant as change agents |
| Deficits in clinical leadership and change management skills | Facilitating development of clinical leadership skills [46] |
Increased ability to understand and manage implementation in complex environments Increased awareness of the importance of leadership in change processes | Interactive mini-lectures on leadership, implementation and change management |