Table 1 Realist programme theory summary
From: The influence of contextual factors on healthcare quality improvement initiatives: a realist review
C. Context | I. Inputs/resources | M. Key mechanisms | M. Other mechanisms | O. 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’ context | Solution/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 Contextualisation | Rate/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 |