Table 1 Summary of main themes by level, mapped to theoretical domains framework (13) and COM-B (14)

Capability

Knowledge

• Variation in stakeholder knowledge of processes for collaborative R&I

• Variation in whether organisations have processes for collaborative R&I

• Processes are clearer for research than innovation

• Need for collaborating organisations to be protected through formal agreements, and data sharing agreements

Knowledge of processes for R&I made difficult as ICB and ICS development has meant that such processes are in flux

Skills

• Communication and relationship building skills are necessary to bring multidisciplinary teams together for collaborative R&I

• Research skills vary within organisations

• Communication and relationship building skills are necessary to bring multidisciplinary teams together for collaborative R&I

• Research skills vary across organisations

• Collaboration is beneficial for research skill-sharing

• Need better awareness of where research expertise is across the ICS partner organisations

Opportunity

Environmental Context and Resources

• COVID-19

- Increases in remote working increases have negatively impacted opportunities to collaborate

- COVID-19 R&I (e.g., vaccine development) showed that collaborative, dynamic R&I is possible when traditional barriers are removed

- Changes in research focus led to new partnerships

• Importance of organisational culture to ensure that R&I is prioritised

• Traditional competition around research remains dominant, highlighting a need to shift from competition to collaboration

• COVID-19 impact on the system

• Pressured economic environment

Motivation

Social/ Professional Role and Identity

• Individuals do not always feel supported to encouraged to undertake joint research

• Organisations at different stages of development for research

• Organisational commitment is required at board and senior leadership levels

• True collaboration involved a collective responsibility and shared risk

• Need to harmonise research across participating organisations, while recognising institutional targets

Beliefs about Capabilities

• Variation in organisational confidence for R&I

• A fear of failing prevents innovation

• Track record and credibility for research fosters collaboration

Beliefs about Consequences

• Belief that collaboration is beneficial (skill-sharing, collective strength)

• Imbalanced collaborations can be detrimental:

- Small partners not being heard / larger organisations dominating

- Larger organisations assume more workload than planned (if there is lack of engagement from smaller partners)

- Unequitable allocation of finances

• Need agreements around workload and have common aims

• Belief that collaboration is necessary:

- to cover the R&I needs of a large and diverse ICS geography

- as services are integrating across partner organisations, so must R&I

Goals

• Individuals lack time for innovative activities to facilitate goal of increasing collaborative research

• To build R&I representation at organisational board-level

• To undertake more collaborative research

• Specific actions to achieve goals include:

- A shared framework for R&I across ICS partner organisations

- Having a shared directory

- Running webinars and events to foster partnership

- Having have shared roles to increase capacity and address skill needs

Optimism

• Pessimism about lack of capacity for research when it is not a core part of individual’s job roles

• Optimism regarding the benefits of collaborative R&I through:

- Shared risks

- Stronger study teams

• Pessimism about:

- The integrity of collaborations and trust for sharing of ideas (i.e., competitive culture remains)

• Optimism about a prominent role for R&I in the ICS

• Optimism regarding the benefits of collaborative R&I through:

- Attracting larger studies to the region

- Collective expertise and strength

- Allowing higher quality research and more innovation

- Lead to better services/care and patient outcomes