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Table 1 Realist programme theory summary

From: The influence of contextual factors on healthcare quality improvement initiatives: a realist review

C. ContextI. Inputs/resourcesM. Key mechanismsM. Other mechanismsO. Outcomes
C1 National policy context
National drivers
National QI support
Continuous QI culture
Policy frameworks and strategies
National improvement programmes
Resources
M Consistently supporting and encouraging improvement (coherent message)
M National/strategic application of QI
Continuous focus on QI
Fit between national agenda and local priorities
QI-related outcomes
-sustainability
-scale and spread
Health improvement outcomes
Practitioner (clinical/frontline) outcomes
Contextual outcomes
Negative/unanticipated outcomes
C2 Organisation
Leadership
Culture
Systems & processes
Policy frameworks
National improvement programmes
Local improvement programmes
Resources
In-house QI support/coaching
M Organisational responses
M1 Strong leadership
M2 ‘Creating the culture’
Top-down:
Strategic/administrative engagement and participation
Multi-disciplinary collaboration
C3 Clinical microsystem (Frontline)
Context of change
Developing capacity and capability
Evidence for change + Intervention
Diagnostic work (contextualisation)
QI approach
M2 ‘Creating the culture’
M3 Frontline engagement
M Developing capacity for improvement
M Co-creation/co-production
M Ownership
M4 Informed practitioners
Bottom-up:
Buy-in/commitment
Ownership
C4 STAKEHOLDERS
Context of individual change
QI approach
Evidence for change + Intervention
M3 Frontline engagement
M Co-creation/co-production
M4 Informed practitioners
M Common understanding and language
M Buy-in/commitment
Passion vs resistance
‘Having the conversation’
‘Permission’
‘The Problem’ contextSolution/intervention (the IDEA; the ‘change’)M3 Frontline engagement
M Awareness
M Willingness
‘Permission’
Short-term QI [project] context
Implementation context
QI approach/activity
Intervention
Introducing/testing change
M ‘Will— ideas—execution’
M Aligning
Ownership
Long-term QI context
Post-intervention context
Intervention
QI approach
M ContextualisationRate/pace of change
Long-term embedding
Learning context (‘journey of improvement’)QI approach
QI mentoring
M4 Informed practitioners
M Choice
M Starting the journey
Sharing ‘what works’
Relationship with failure