Facilitators and barriers to the implementation of new critical care practices during COVID-19: a multicenter qualitative study using the Consolidated Framework for Implementation Research (CFIR)

Table 4 (Results) Qualitative themes, organized by implementation facilitators/barriers across the CFIR domains

CFIR Domain	CFIR Construct	Implementation Determinant	Theme
Intervention Characteristics	Innovation Source	Facilitator	Practices informed by both external & internal sources
Intervention Characteristics	Complexity	Barrier	Increased complexity of COVID-19 critical care practices
Outer setting	Cosmopolitanism	Facilitator	Strong partnerships with external stakeholders
	Cosmopolitanism	Barrier	Lack of consistent, reliable, & peer-reviewed guidance from trusted external resources
	Needs of Patients; External Policy	Barrier	Strict external infection prevention measures & policies that isolated patients
Inner setting	Networks & Communications	Facilitator	Coordinated & collaborative network/ communication structures
	Leadership Engagement	Facilitator	Strong leadership engagement, accessibility, & physical presence
	Available Resources	Barrier	Lack of PPE, medical equipment, ICU-trained staff, space, & technology
Characteristics of individuals	Knowledge & Beliefs about the Changes	Facilitator	Staff resilience & receptiveness to change
Characteristics of individuals	Knowledge & Beliefs about the Changes	Barrier	Low staff morale & high burnout
Process	Engaging Staff	Facilitator	Effective staff engagement strategies
Process	Implementation Leaders	Barrier	Authoritarian decision-making

ISSN: 1472-6963