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Table 1 Framework for the qualitative interviews

From: Taking hospital treatments home: a mixed methods case study looking at the barriers and success factors for home dialysis treatment and the influence of a target on uptake rates

Factors Demonstrated by
Level 1: individual clinicians and patients [20, 21]
Clinical pathway A clear and up-to-date home dialysis pathway is in place and used by staff
Patient choice of treatmenta Patients are provided with timely and relevant information in a variety of formats to support their choice of treatment
  Staff promote home dialysis positively
Equipmenta There is an appropriate range of dialysis equipment available
  All staff have a good working knowledge of the dialysis equipment
  Patients can try out equipment before making a choice about treatment
  Property adaptations are timely
  Technical support, maintenance and adjustment to dialysis equipment is provided
Patient training and supporta High-quality patient training for home dialysis is provided using a variety of methods and techniques
  Peer support is available
  Ongoing support is provided to patients and carers
Patient feedback Patient and carer feedback mechanisms are in place and are used by staff to adjust how they work
Level 2: renal team [20, 21]
Vision All staff share the vision and understand the home dialysis target
Leadership There is visible and clear clinical and managerial leadership for home dialysis from trusted and influential individuals
  Leaders take personal responsibility, giving time to be involved and actively promote home dialysis
  Mechanisms are in place and used to overcome resistance to change
Staffing Staffing competencies, grades and levels are consistent with the target
  The home dialysis target is reflected in job descriptions and appraisals
  Skill and training gaps are identified; training and development is put in place to address gaps
Culture Staff have positive attitudes and support the target
  Staff at all levels are involved in planning and making changes to home dialysis, and their ideas and input are valued and used
  Innovation and change are actively promoted and staff are encouraged to try out new ideas for home dialysis in practice
Resources Sufficient resources are available to meet the target (staff, equipment and funding)
Level 3: organisation (hospital) [20, 21]
Strategy The target contributes to the organisation’s current vision and strategy and is reflected in existing plans
  There is director-level sponsorship and senior leaders understand and actively promote the target
Incentives Incentives for home dialysis are aligned with achievement
Level 4: wider NHS system [20, 21]
Policy National and regional policy supports the target
Commissioning The commissioner’s strategy and contracting is aligned with the target
  The tariff and incentives/penalties are aligned with the target
Level 5: change management [20]
Planning A clear and realistic plan is in place for increasing uptake rates
  The baseline is mapped, and timely and accurate information is available to track progress
  Achievement against the plan is reviewed regularly, communicated to staff and adjusted when needed
Resources Staff with the right skills and available time are leading the required changes
  1. aItems added to the evidence-based framework from national renal policy documents