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Table 6 Joint display potential

From: A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory

Potential: Social-cognitive resources available to agents (Individual intentions & Collective commitment)
  AR
(IR)
SrA ↑↓ LOS (ΔLOS) Qualitative data
Hospital 1 75%
(10%)
88% ↑17
↓5
(6.0d)
(−3.1d)
• Willingness to change was present, team wanted to improve further
• Quality improvement is considered important within hospital
• CP development is team effort, with collective goals
• CP development aligned with hospital strategy, higher management decided to join the project
Hospital 2 65%
(22%)
60% ↑18
↓3
8.2d
(− 4.2d)
• Improvement team was motivated
• Motivation hampered by conflicting priorities
• Identifiable collective reason to start project
• CP development aligned with hospital strategy, higher management decided to join the project
Hospital 8 47%
(−13%)
71% ↑6
↓9
10.3d
(−4.4d)
• Little motivation and collective commitment
• Certification, external pressure as leverage for CP development
• Conflict of views on quality: administrative vs clinical approach
• CP development not aligned with hospital strategy, middle management decided to join the project
Hospital 9 54%
(−3%)
72% ↑13
↓6
10.2d
(2.1d)
• Lacking shared goals and commitment
• External pressure provides leverage for CP development
• Management not involved, quality improvement as ‘part of the job’
• CP development not aligned with hospital strategy, team decided to join the project
Hospital 10 64%
(−5%)
64% ↑7
↓8
18.8d
(1.8d)
• Feedback of the pre-test data acted as trigger, team intrinsically motivated
• Quality improvement perceived as important part of the job, project as opportunity to update local protocols, benchmark and learn
• CP development is a team effort, with shared ambitions, but more so on the ward where medical champion worked
• Little to no support by management, and different views on quality between management and clinicians
• CP development is not aligned with hospital strategy, middle management decided to join the project
  1. AR Adherence rate post-test, IR Improvement rate, SrA Self-rated adherence, ↑↓ number of interventions on which adherence went up or down, LOS length of stay post-test, ∆LOS change in mean LOS (days)