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Table 2 Propositions used to further refine the explanatory model

From: Implementation of safety checklists in surgery: a realist synthesis of evidence

Proposition Mechanism of implementation Coherence with middle-range theory (supporting data from review studies)
Checklist protocols that are prospectively tailored to the context are more likely to be used and sustained in practice. Process simplification Normalisation Process Theory
 • Keeping it simple
 • Modifying to reflect workflow
 • Tailoring to context
Reflection
 • Collective learning
 • Monitoring
 • Feeding back
Fidelity and sustainability is increased when checklist protocols can be seamlessly integrated into daily professional practice. Process simplification Normalisation Process Theory
 • Keeping it simple
Responsive Regulation Theory
 • Modifying to reflect workflow
 • Tailoring to context
Reflection
 • Collective learning
 • Monitoring
 • Feeding back
Routine embedding of checklist protocols in practice is influenced by factors that promote or inhibit clinicians’ participation. Active leadership Responsive Regulation Theory
 • Discipline leader
Normalisation Process Theory
 • Frontline decision-making
 • Active participation
Support strategies
 • Controlled roll-out
 • Support without sanction
 • Communicating the message
Process simplification
 • Keeping it simple
 • Modifying to reflect workflow
 • Tailoring to context
Reflection
 • Collective learning
 • Monitoring
 • Feeding back
Regulation reinforcement mechanisms that are more contextually responsive should lead to greater compliance with using checklist protocols. Active leadership Responsive Regulation Theory
 • Discipline leader
 • Frontline decision-making
 • Active participation
Support strategies
 • Controlled roll-out
 • Support without sanction
 • Communicating the message