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Table 3 Contextual domains

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

DomainHow?Why?When?For whom?
LeadershipLeaders enthusiastic about change had a motivational effect on staff, and the involvement of leaders or executive sponsors lead to a more positive experience of improvement.Encouraging leadership leads to shared responsibility and increased accountability—promoting progress and staff empowerment.To support motivational efforts and address operational and organisational barriers.Professional groups and frontline staff.
Organisational characteristicsEmpowers individuals/teams to achieve change. Formal structures (data, training) influence how an organisation delivers improvement initiatives.The QI infrastructure reflects an organisation’s ability to intentionally, and systematically use improvement approaches to change processes and improve outcomes. It demonstrates an organisation’s readiness for change.Planning and pre-implementation phases—prior to the adoption or spread of an improvement initiative.Individuals and frontline teams.
Change agentsDrive initiatives, enable others and/or hold teams accountable for implementation.Facilitate engagement with stakeholders, and help teams identify problems, develop solutions and understand the use QI methodologies.All stages in the improvement journey.A wide range of staff, including individuals and frontline teams.
Multi-disciplinary collaborationFosters team ownership and shared goals across the organisational system levels.Flattens hierarchies and aligns the interests of multiple stakeholders.All stages in the improvement journey.Actors at various organisational and system levels.