Table 4 Barriers and constraints related to implementation and sustainability of WTMS experienced by workshop participants (new factors in bold)
| Â | Implementation | Sustainability | ||
|---|---|---|---|---|
Local level | Contextual level | Local level | Contextual level | |
Governance | • Lack of coordination among provider groups | • Limited information sharing | • Lack of management of critical diagnostic, surgical and continuity of care interdependencies | • Limited information sharing |
• Limited information sharing | • Competing health system priorities | • Lack of time allotted to WTM strategies | • Competing health system priorities | |
• Lack of leadership for solutions | • Lack of leadership for solutions | • Limited information sharing | • Lack of shared learning opportunities among jurisdictions | |
|  |  | • Lack of clinical-administrative partnerships |  | |
Culture | • Competing cultures | • Lack of systematic approach to implement culture change | • Prevalence of a ‘blitz mentality’ among healthcare innovators | -------- |
• Lack of evidence about value of WTM strategies | • Resistance to change and uncertainty |  |  | |
• Resistance to change and uncertainty |  |  |  | |
Resources | • Lack of incentives (physician payment systems) | • Incentives (physician payment systems) | -------- | • Lack of funding |
• Insufficient number of administrative staff | • Lack of funding |  |  | |
Tools | • Poor resourcing of technology and staff | • Lack of standardized data | --------- | --------- |
|  | • Lack of change management support and tools |  |  |  |