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Table 6 Common and distinct factors influencing synoptic reporting tool (SRT) implementation and use across cases

From: Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting

Factor

Case A: Mammography case

Case B: Endoscopy case

Case C: Cancer surgery case

Common factors

   

Stakeholder involvement

+/− Initial implementation and use were facilitated by stakeholder involvement; subsequent expansion was impeded by low stakeholder (i.e., radiologist) involvement

- Implementation was impeded by limited stakeholder involvement

+ Implementation was facilitated by early, ongoing, and collaborative stakeholder involvement

Managing the change process

- Implementation and use were impeded by sub-optimal change management practices

- Implementation and use were impeded by sub-optimal change management practices, though user training was well conducted

+ Implementation and use were facilitated by high-quality change management practices

Administrative and managerial supporta

+/− Implementation was facilitated by high administrative support and high managerial support in some hospitals; implementation was impeded by low managerial support in other hospitals

+/− Implementation was facilitated by high administrative support; implementation was impeded by low managerial support in many hospitals

+ Implementation was facilitated by high administrative and managerial support

Champions and respected colleagues

+/− Implementation and use were facilitated by clinical and administrative champions; lack of clinical champions in some districts impeded use

+ Implementation and use were facilitated by clinical champions and respected clinical colleagues

+ Implementation and use were facilitated by clinical champions and respected clinical colleagues

Innovation attributes

+/- Implementation and use were facilitated by alignment with individuals’ and organizations’ values, interests, and needs; use was impeded by perceived tool (and final report) deficiencies and its relative (dis)advantage in practice

+/− Use was facilitated by the tool’s perceived ease of use, but impeded by IT and other technical issues; implementation and use were facilitated by alignment with individuals’ and organizations’ values, priorities, and interests

+/− Use was facilitated by the tool’s perceived ease of use, but impeded by accessibility and IT issues; implementation and use were facilitated by alignment with individuals’ and organizations’ values, priorities, and interests

Distinct factors

   

Implementation approach

NA

+ Implementation and use were facilitated by the tool’s positioning in the provincial screening program (however, the top-down, policy driven approach was met with much resistance)

+/− Implementation was facilitated by the tool’s positioning as a pilot project; use was impeded by its positioning since the team had no authority to influence use (e.g., through policy)

Project management

NA

- Implementation was impeded by suboptimal project management, specifically related to the tool’s implementation

NA

Resources

- Implementation and use were impeded by insufficient resources for SRT development/updates, implementation, and expansion

NA

- Implementation was impeded early in the project by insufficient IT resources

Culture

+ Implementation and use were facilitated by the program’s strong quality improvement culture; however, this strong culture was viewed negatively by some users, possibly influencing expansion

NA

NA

Leadership

+ Implementation and use were facilitated by consistent, effective leadership

NA

NA

Monitoring and feedback mechanisms

+ Implementation and use were facilitated by ongoing monitoring and feedback mechanisms

NA

NA

Components of the healthcare system

NA

- Implementation was impeded by structural, infrastructural, and socio-historical components of the healthcare system

- Implementation was impeded by relational and infrastructural components of the healthcare system

  1. Depending on the context, the factor was a facilitator or barrier to implementation and use; + indicates a facilitating influence, - indicates an impeding influence.
  2. NA = not applicable.
  3. aAdministrators = executive officers, directors, and senior management at the Department of Health, health district, and hospital levels; management = managers and heads of organizational departments and units.