Fig. 2

Potential interactions within the Capability, Opportunity, Motivation and Behavior (COM-B) model that could support collaborative quality improvement projects in hospitals. Adapted from Ref 20. Capability is defined an individual’s ability (psychological or physical capability) together with the available opportunity (an attribute of the environmental system and thus outside of the individual) that facilitates it. Motivation is defined as all brain processes that energize and direct one’s behavior. There is a distinguishing topic related to motivation between reflexive and automatic processes. Reflexive motivation involves evaluation and planning, including organizational motivation. According to our data, the support of managers, the QI team and institutional policy are the reflexive drivers of motivation. Automatic motivation involves instinctive, habitual, and affective processes. To the best of our knowledge, understanding why, participating in changes and achieving results are considered the main forces