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Table 4 Results of the cross-case analysis

From: The implementation of change model adds value to value-based healthcare: a qualitative study

Steps of the ICM Theme that emerged from cross-case analysis Representative quotations
1. Development of a proposal for change Support R6:“The people who perform it are often not involved in such a thing.”
R2: “So you are asking for extra commitment from people; if you ask, you also have to return something. If that does not happen, and there is not much support in advance, then it will break down.”
2. Analysis of actual performance Personal importance of the target R7:“We have all looked at whether this is a feasible goal and how can we do it all based on the analysis we had.”
R5: “Certainly, the goal is that every patient who is undergoing an aortic valve replacement receives a protein-enriched diet (…). That it becomes a standard of care is actually the goal; it must be a standard concern.”
3. Problem analysis of target group and setting Involvement R2: “So that you’re involved, that you should receive the result, so that’s important”
R6: “I was always kept up to date, so that was nice”.
R2: “Yes, I think it’s important that everyone is involved. In particular, because if it does not happen, or someone forgets or does not feel like it, or quickly wants to do it, that someone in that operation room, even if it’s the operation nurse, can say: ‘Hey, those questions should also be asked.’ If the whole team knows that the question has to come up, they will do it, but if only the surgeon knows and he forgets, you think: yes, it happened again.”
R2: “I think in advance, everyone’s role should be clearer, not just the one who does it, the surgeon and the anaesthesiologist, but also the others.”
4. Development and selection of strategies and measures to change practice Leadership R2: “So in the group, that is certainly decisive in the operation room, there was a difference in opinion that did not really help. If all surgeons would say: ‘No, we should definitely do that’, that is important.”
5. Development, testing and execution of the implementation plan Climate R1: “I think that the climate is good and that people feel free to indicate that. That is also one of the prerequisites for successfully implementing something like this, that every player on the team is free and feels free to simply say what he or she thinks.”
6. Integration of changes into routine care No theme across cases identified Not applicable
7. Continuous evaluation and adapting plan Monitoring R2: “If you see after two weeks that only half of the patients have been done, you should say: It was only 50%; it should improve. And then you have to go back two weeks later to make sure that you get 60%. Otherwise, you have to talk to people about: How did this happen?”
R3: “We have been sitting extensively on those Thursdays, what should change to improve the success of the implementation and whether there are additional patient groups that can be included.”
R8: “Yes, sometimes sending a mail like: guys, remember it.”