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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)