Table 2 Outer setting: constructs with definitions, themes, and illustrative quotations

Patient needs and resources

The level of understanding within the health service of the needs of older people undergoing surgery, and the barriers and facilitators to meeting those needs.

Understanding and prioritising the needs and priorities of older people undergoing surgery supports the implementation of POPS services.

“Older people need more holistic care and not just, ‘oh we’ll fix the fracture and send them on their way’ … it is quite hard to look after older people and if we all work together we do a better job … [POPS results in] this team mentality and everyone is enthusiastic.”

(Case 2, POPS fellow)

Cosmopolitanism (external networking)

Networking of the health services with other organisations.

At health services without a POPS service, networking with external well-established POPS services and their clinical leads facilitates implementation.

“I don’t think I had a lot of formal training but I’ve learnt as I’ve gone along with the support from [case 1 POPS clinical lead] who has done it before.”

(Case 3, POPS clinical lead)

External policies and incentives

The role of external initiatives to spread interventions.

Financial incentives can assist with the implementation of the POPS service but are not an essential factor.

“[To receive the Best Practice Tariff, patients are] supposed to have a frailty score within 72 hours [of admission] so we tagged on that they should get a full geriatric assessment.”

(Case 2, physiotherapist)