Table 6 Key differences based on interviews with program owners and professionals
Stable high fidelity cluster (n = 9) | Moderate and improving fidelity cluster (n = 6) |
|---|---|
Adoption period a | |
Organization’s starting positionb was high (n = 3), moderate (n = 4) or low (n = 2) | Organization’s starting position was high (n = 2) or low (n = 4) |
-The organizations (n = 2) with low starting positions improved within a short period | -The organizations (n = 4) with low start positions improved within a moderate to long period |
“They [professionals in one organizations] prepared the implementation [of the program] within 3–4 weeks. This illustrates their fast improving ambition levels.” [Quote from a program coordinator] | “It was a very difficult starting process, because of the many staff-turnovers at management level.” [Quote from a program coordinator] |
Ambition level during adoption | Ambition level during adoption |
-High ambition level (n = 6) | -High ambition level (n = 2) |
-Ambition level was not discussed (n = 3) | -Moderate to low ambition level (n = 3) |
-Ambition level was not discussed (n = 1) | |
Implementation period a | |
Role of physicians | Role of physicians |
-Proactive role before the start (n = 4) -Active engagement during implementation (n = 9) | -No or less active engagement before and during the implementation (n = 6) |
“In 2011, we presented our Handbook at a national meeting organized for rehabilitation physicians. Afterwards, he [a physician of a participating organization] came to me and said ‘I really want to have that Handbook, because I want to implement that program’ [RSE].” [Quote from a program coordinator] | “It was a conscious choice. […] At the start of the project, we were in the middle of a re-organization. And during that time, we were understaffed. And we tried to involve a physician, but it didn’t worked out.” [Quote from a project leader and counselor] “We have to start a project, and none of the physicians had time [to be member of the work group]. […] And that’s why one of the physicians was involved from the background, as a sounding board for me. […] But nobody participates in the work group. [Quote from a project leader] |
Changes in organizations | Changes in organizations |
-The impact of staff turnover processes was not explicitly discussed during interviews (n = 9) | -Staff turnover processes delayed the implementation (n = 2) |
-Reorganizations took place (n = 1) | -Reorganizations took place (n = 3) |
Organization’s vision and strategy | Organization’s vision and strategy |
-The majority (n = 8) had an explicit vision and strategy about the implementation of the program | -The minority (n = 1) had an explicit vision and strategy about the implementation of the program. |
“They implemented a standardized group-based intake session [of the program]. At the start of the rehabilitation treatment, all patients receive a group-based intake session about sport and exercise opportunities.” [Quote from a program coordinator] | “Eventually, I mainly used the Handbook [of the program] to write the project plan. [..]. That [Handbook] was a very useful tool.” [Quote from a project leader and counselor] |