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 |