Table 3 Inner setting: constructs with definitions, themes, and illustrative quotations
Construct | POPS-specific definition | Theme | Illustrative quotation |
|---|---|---|---|
Networks and communications | The nature and quality of relationships and connections between individuals, clinical units and teams that interact with the POPS service. | Networks at multiple organisational levels facilitate sharing of vision and define team members’ roles, which enables delivery of POPS services. | “[The POPS clinical lead and I] communicate very effectively and I know historically [at other health services] there’s been fragmentation between the way anaesthetists do their preoperative assessment and the way the POPS team do and we were quite careful to work together to avoid that becoming a problem and have achieved that completely.” (Case 3, anaesthetist) |
Implementation climate | |||
Tension for change | The extent to which clinicians and managers feel the care provided to older people undergoing surgery needs to change. | The presence of an unmet clinical need results in a tension for change that facilitates the implementation of POPS services. | “I think the model of care is quite well suited to our hospital … we don’t have a [physician-led] medical service yet we’re an acute hospital… [with] acute vascular, renal [services].” (Case 3, physiotherapist) |
Compatibility | The level of alignment between the POPS service and a clinician or manager’s goals, skill mix and values. The perceived risks and benefits of introducing a POPS service. | POPS services may be perceived as a threat when clinicians do not see a clinical need the service can meet; POPS services are thus viewed as a risk to autonomy or territory. | “The other thing that has been problematic is the relationship between the anaesthetic perioperative team and [POPS]. Some of the anaesthetists think, ‘what’s the point [of POPS assessment]?’ … I think that that can be a barrier to spreading [POPS] because people can use some of this as empire building.” (Case 2, surgeon) |
Learning climate | A climate with time and space for leaders to feel and express fallibility, team members to feel valued and able to assist leaders, and which safely enables trial and error. | POPS clinical leads role-model and drive a learning climate that supports implementation. | “[POPS] feels much more supportive than other ward rounds, [it] is much more integrational [sic]. People feel that they’re able to speak up and ask questions so I think that’s what it brings to [improved safety and quality].” (Case 1, surgical matron) |
Readiness for implementation | |||
Available resources | Financial, education, physical and time-based resources that are dedicated for implementation and use of the POPS service. | The implementation of POPS services can be enabled by adequate resources for staffing, financial support and education. | “[Our POPS service is] fortunate … teaching hospitals with good reputations attract good people and so they’re well resourced.” (Case 1, board member) |
Access to knowledge and information | The ability for users of the POPS service to be easily educated about what the POPS service is and how to engage with it. | Knowledge and information about the why, what and how of POPS services is necessary for implementation and can be provided through multiple channels according to local needs and capabilities. | “Education’s important. I went to a meeting and [the POPS clinical lead] was talking [about POPS] and it was amazing. I’d never heard anything about it before … That’s very important, when you’re just starting out, to make yourself known widely.” (Case 1, anaesthetist) |