Table 2 Impeding or facilitating factors for implementation

Protocol level

1. Unclear protocol

1.1. Lack of protocol

1.2. Too many protocols

1.3. Time-consuming intervention actions after screening

1.4. Difficulties due to patient privacy

1. Well-developed protocol

1.1. Presence of protocol

1.2. User-friendly protocol

1.3. Embedded in the system

1.4. Incorporating lifestyle-wide intervention approaches

Individual level

1. Lack of professionals’ motivation

1.1. Decrease in attention to theme

1.2. Forgotten

1.3. Distrust in usefulness and effectiveness

1.4. Perception that it is not their job

1.5. Irrelevant for care demand of patient

1.6. Alcohol not recognized as problem

1.7. Resistance care professionals

1.8. Resistance (partnerships) physicians

1.9. Resistance pharmacists

1.10. Resistance general practitioners

1. Enhancing professionals’ motivation

1.1. Emphasizing interventions’ importance

1.2. Feedback on effect of intervention

1.3. Presence of clinical “champion”

1.4. Peer coaching

1.5. Reminding each other

1.6. Showing perseverance

1.7. Enhancing feelings of responsibility

1.8. Involving professionals in protocol development

1.9. Higher motivation present in specific departments

1.10. Higher motivation present if relevant to patient care demand

1.11. Commitment project group

2. Lack of professionals’ knowledge and skills

2.1. Lack of knowledge regarding alcohol (problems)

2.2. Not knowing how to start conversation

2.3. Loss of knowledge due to staff turnover

2.4. Not knowing where to refer to

2. Enhance professionals’ knowledge and skills

2.1. Training

2.2. Knowing how to start conversation

2.3. Gaining experience with alcohol problem patients

2.4. Limited staff turnover

3. Difficulties in patient contact

3.1. Patient unaware of the problem

3.2. Patient still intoxicated

3.3. Patient does not answer honestly

3.4. Language/cultural barriers

3.5. Patient aggressive or insulting

3.6. Patient unmotivated

3.7. Multiple problems patient

3. Support from patient

3.1. Patient receptive to alcohol intervention

3.2. Involvement patients’ social network

Organizational level

1. Poor collaboration/support

1.1. Difficulties involving general practitioner

1.2. Hard to keep multidisciplinary project group together

1.3. Absence of physician during consultations

1.4. Vulnerable transfer of (patient) information after discharge

1.5. Dependence on operating hours and schedule

1.6. Resistance hospital management

1. Good collaboration/support

1.1. Knowing the network

1.2. Cooperating in multidisciplinary project group

1.3. Presence of physician during consultations

1.4. Having collaboration agreements between parties

1.5. Collaboration between hospital departments

1.6. Collaboration in the health care chain (parties outside hospital)

1.7. Collaboration general practitioner

1.8. Commitment hospital management

2. Lack of resources

2.1. Lack of finances

2.2. Lack of staff

2.3. Lack of time

2.4. Limited care possibilities due to insurers’ Diagnosis-Treatment-Combinations (DTC)

2. Sufficient resources

2.1. Sufficient finances

2.2. Sufficient staff

2.3. Sufficient time

2.4. Hiring counsellor/task-specific employee

2.5. Insure patients holistically, without Diagnosis-Treatment-Combinations (DTC)

3. Unclear role responsibility

3.1. Disagreements about role responsibilities

3. Compatible with role responsibility

3.1. Compatible with role of physician

3.2. Compatible with role of nurse

3.3. Compatible with role of general practitioner

Societal level

1. Lack of societal support

1.1. Lack of national information

1.2. Negative image of addiction care

1.3. Social acceptance of drinking alcohol

1.4. Intervention perceived as premature

1. Societal support

1.1. National information

1.2. Governmental regulations