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Table 7 Joint display contribution

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

Contribution: What agents do to implement a complex intervention (Coherence, Cognitive participation, Collective action & Reflexive monitoring)
  AR
(IR)
SrA ↑↓ LOS (ΔLOS) Qualitative data
Hospital 1 75%
(10%)
88% ↑17
↓5
(6.0d)
(−3.1d)
• Model CP as refresher, evidence base valued, feedback shared in improvement team
• Positive expectation of patient and team outcomes
• Benchmarking with other hospitals valued
• 9 disciplines involved
• Activities: updating protocol, training, communication, meetings
• Feedback and monitoring perceived as crucial, and routinely used
• Plans ready for future development of CP
Hospital 2 65%
(22%)
60% ↑18
↓3
8.2d
(−4.2d)
• Evidence base of model CP valued, feedback from pre-test discussed with individuals
• Ambivalent outcome expectations
• Benchmarking with other hospitals valued
• 5 disciplines involved
• Activities: updating protocol, meetings, mandatory training, laminated poster, development of CP took longer than expected
• Follow-up of data, monitoring and feedback perceived as frustrating due to manual data retrieving
• Plan for further development
Hospital 8 47%
(−13%)
71% ↑6
↓9
10.3d
(−4.4d)
• Model pathway perceived as logical, clear (but not implemented)
• CP could help to organize some of the care, positive
• Unclear if and how feedback from pre-test was communicated
• No improvement team, no activities
Hospital 9 54%
(−3%)
72% ↑13
↓6
10.2d
(2.1d)
• CP desired, but unknown, questioning applicability of some interventions, unclear if feedback was spread
• No change in patient outcomes was expected
• Benchmarking with other hospitals valued
• 4 disciplines involved
• Activities: updating protocol, limited training, crucial role for head nurses
• Feedback and monitoring perceived as crucial, but not used routinely
• Desire to develop more CPs and work with improvement team
Hospital 10 64%
(−5%)
64% ↑7
↓8
18.8d
(1.8d)
• Model CP valued, questioning applicability of some interventions, feedback shared beyond improvement team
• Positive expectation of patient and team outcomes
• Benchmarking with other hospitals valued
• 4 disciplines involved
• Activities: updating protocols, meetings, 1-on-1 instructions, communication, CP printed in patient record (reminder)
• Feedback and monitoring is used, a number of indicators from the model CP was added for routine monitoring
• Plan for new patient record analysis
  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)