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Table 6 Identified barriers and facilitators to implementation

From: Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

Domain Sub-domain Brief description Number of included studies citing barriers or facilitators in this domain
Environmental context IT, trial staff, time, workload, workflow, competing trials, space, movement and staff turnover The physical, structural resources of the context, along with its processes and personal resources 37
Culture Attitude to change (readiness and agents), commitment and motivation, flexibility of roles/trust, champions/role models The system culture, beliefs and behaviors in relation to change and staffing roles 28
Communication processes Processes within the context The processes of conveying information within the system, in terms of both online and in-person methods 25
External requirements Reporting, standards, guidelines Any external pressures or expectations that impact on the deliverables of the system 4
Staff commitment and attitudes Perceived validity/need, ownership, perceived efficiency, perceived safety, belief in change/readiness for change The micro-level beliefs, attitudes and behaviors toward change in general, and the intervention specifically 33
Understanding/awareness Of the goals of the intervention, and of the processes/mechanics Understanding of the aims and methodology of the intervention 22
Role identity Flexibility, responsibility Beliefs and attitudes towards one’s work role and responsibilities 13
Skills, ability, confidence To engage patients and overcome patient barriers, to carry out the intervention, to manage stress/competing priorities Staff sense of their capacity to carry out the tasks of the intervention, while managing the barriers posed by the target population and their work environment 30
Ease of integration Complexity, cost and resources required, flexibility (to respond to patient, staff and system), acceptability/suitability to system, staff and patients; fit for context How well the intervention “fits” with the current system, resources and needs of the population and context, as well as its ability to adapt and respond when changes are needed 30
Face validity/evidence base Theory and evidence The extent to which the intervention is grounded in solid evidence regarding a known issue, and how effective it looks to be in terms of meeting its aims 12
Safety/legal/ethical concerns Patient or staff safety; medico-legal concerns How well an intervention addresses important issues of safety and legality to protect staff and patients 6
Supportive components Education/training provided, marketing/awareness, audit/feedback, involvement of end users The components of the intervention which work to support and facilitate the changes necessary 38