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Table 5 Contextual factors

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

DomainFactorDescription
LeadershipLeadershipSupportive, active, engaged, effective, consistent, motivational, accessible, credible. Belief in QI. Blended leadership approach (top-down/bottom-up).
Organisational characteristicsOrganisational cultureCore values, attitudes, norms, systems, processes. Underlying ethos and principles. History. Implementation climate. Organisational commitment.
Individual skills and capabilitiesIndividuals and groups/teams: QI expertise, understanding prior experience. Training, learning, development of a skill set to address ‘QI skills gap’.
Organisational capacity and capabilityImprovement culture, prior initiatives, QI history and maturity. QI capacity. Developing or ongoing ‘organisational learning’.
Availability of dedicated resources.
Data and technical infrastructureSystems, measurement, monitoring, feedback: availability and use of data as a motivator to improve. Information systems in place to support systematic and standardised collection and use of data for improvement. Integration of data collection into existing practices to minimise ‘burden’ on staff. Technical capability of staff to use data.
Readiness for changeReceptiveness, shared resolve, belief, support, commitment, collective change efficacy.
Change agentsChampionshipChange agents: driving and leading change. Ownership, engagement, participation.
Multi-disciplinary collaborationRelationshipsCollaboration: multidisciplinary, formal/informal, external. Strong working relationships. Facilitation of communication across all levels. Support for networks. Consensus-building.