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Table 3 Example of quotes illustrating the different determinants perceived to influence task shifting implementability

From: Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

Implementability determinants Illustrative quotes
Knowledge of and acceptability of task-shifting rationale It (the task shifting project) should be discussed with all stakeholders (…). It is not a good idea to introduce something that a group is critical towards from the beginning, as it often leads to adversity. (Nurse1)
Task shifting must be acceptable to both groups. (Doctor2).
Dynamic role boundaries Solving the tasks in the best possible and most efficient way is of highest importance, who performs them is less important. (Doctor1)
Sometimes we should stop and think, “what is actually nursing and what is our profession?” (Nurse8).
I think that doctors should perform diagnosis (…) Diagnosing is often about ruling out a lot of stuff too. (Nurse7)
Diagnosis and treatment – that might be our domain (…) It is easier to delegate practical things. (Doctor3)
Technical skills to perform biopsies/aspiration Performing bone marrow examination is a practical task (...) you do the procedure. (Nurse11)
Beliefs about consequences
• outcome efficiency
• outcome quality
• job satisfaction
It becomes more flexible who can perform things. (Nurse4)
Work will be more effective. There are usually more nurses than doctors at work. (Nurse1)
We can spend more time on things that just we can perform (…) taking care of the poorer patients. (Doctor3)
The more people that are involved with (…) a patient, the greater the risk of important information getting lost, which in turn can lead to complications. (Doctor1)
I also think that it (task shifting) may have an opposite effect - that people will quit because they will not do it. Some think it is tough to just be here and do the job they do. (Nurse3)
It is cool to learn something new but (...) you should have a good insight into the patient every single day. Then it is an advantage to have participated in nursing yourself. (Nurse5)
Beliefs about capabilities
• technical skills
• communicative skills
• emotional skills
Bone marrow biopsy (...) I think we are gentler. We are more concerned with how the patient feels. (Nurse8).
Job satisfaction /Esteem A motivational factor is (…) the feeling of climbing a kind of career ladder and getting new challenges (…) and lots of responsibility. (Nurse8)
It (the project) is (…) a declaration of trust. (Nurse1)
Organisational culture
• team positivity
It is a lot about the culture in a unit (...) Culture is actually a prerequisite fo00 success. (Nurse1)
Emotions
• fear of informal nurse hierarchy
• envy
It becomes a kind of hierarchical structure (...) because they (the project nurses) feel that they are (...) better nurses. (Nurse8)
It must not turn into a situation where we set those tasks higher than (...) a traditional nursing job. (Nurse11)
Project planning and leadership
• Structured training
• Time to practice
• Voluntariness
It (the project) must definitely be agreed with and followed up by management and a reasonably clear goal must be set. (Doctor2)
You must have good training (…) Then you have to feel that you can handle it (the task) before you get the full responsibility. (Doctor3)
A prerequisite is that training is under guidance, that those who perform it are feeling safe, and that it is voluntary. (Nurse1)
Patient preferences I do not think it is about profession; it is about them (patients) wanting someone who has done it (the task) many times. A patient would be equally sceptical if a young doctor appears to be very unsure of the procedure, I think. (Nurse4)