Table 2 Context attributes and definitions, listed in order of frequency of attribute occurrence (N = 145 interviews)

Resource Access

Access to any resources. This does not necessarily imply the proximity or closeness of such resources, but only their accessibility in the broadest sense (see physical space).

Time as a resource

Time considered in economic terms: as it is required for the completion of work tasks and as it is managed by staffing and the arrangement of work.

Work Structure

The arrangement of tasks, responsibilities, and resources within and between the various teams working in a clinical setting. This includes factors such as the delegation of tasks among supervisors and subordinates; the arrangement of schedules, shifts, and on-call duties; the order of work tasks and procedures; and the management of workloads.

Scheduling and shift work

Designated work times, the arrangement of work times among a clinical team (including shift work), and other on-call arrangements.

Patient Characteristics

The attributes of individuals under medical care or treatment. This code refers to the characteristics of patients when considered as a group rather than as individuals; thus, all sub-codes considered for inclusion here had to be generalizable to a patient population (an attribute that could be potentially measured and aggregated).

Demographics

Quantifiable characteristics of a patient population including age, sex, weight, number of illnesses or comorbidities, patient acuity, illness severity, and medication history.

Professional Role

A set of expectations, both formal and informal, associated with a given clinical occupation.

Clinical skill set

The technical competencies, knowledge, and abilities that typify a specific clinical role. These are directly related to, and constituted by, the professional role training received during medical training. However, the Skill Set code is differentiated from Professional Role Training code insofar as Skill Set reflects the active employment of a clinician’s particular skills, rather than their acquisition.

Culture

The inherited ideas, beliefs, values, and attitudes of a group.

Organizational culture

The normative beliefs and shared expectations that govern the work behavior of a clinical team or employees of a healthcare facility. These values and expected behaviors are the product of interactions among system members, along with the influence of their work environment, resulting in a common social structure that exists independently and outside individual team members or workers.

Facility Characteristics

The attributes of a building or group of buildings designated as a site for providing healthcare. These characteristics include the type of facility (i.e., a hospital, a walk-in clinic, a trauma center.), the volume of patients cared for at that location, the geographic location, the geographic catchment, and the presence or absence of medical trainees.

Type of facility

The practice setting where a team of clinicians operates. This can include private clinics, hospitals, nursing care homes, public health practices, and specialty practices.

System Features

Distinct characteristics of a group of related parts that move or work together in order for a health care region, organization, hospital, or clinical practice to run effectively.

Record-keeping

The system by which an organization or institution organizes and maintains patient records or charts.

Healthcare Professional Characteristics

The attributes of individuals working as providers of medical care. This code refers to the characteristics of individuals when considered as a group rather than as individuals; thus, all sub-codes considered for inclusion here had to be generalizable to a healthcare professional population (an attribute that could be potentially measured and aggregated).

Experience

Having knowledge or skill in a particular field, especially a profession or job, gained over a period of time. Often used to compare groups with different experience levels (i.e., junior residents vs fellows).

Financial

Monetary receipts (income) and expenditures (costs) relating to clinical behavior or institutional standards.

Funding system

A configuration of services that varies from country to country, but in all cases consists of a financing mechanism, a paid workforce, information on which to base decisions and policies, facilities, and logistics to deliver quality medicines and technologies.

Collaboration

To work jointly with others (including other organizations) or together especially in an intellectual endeavor

Collaboration

Informal communications between team members or other medical professionals that influence the clinical behavior of a healthcare provider.

Leadership

The direction of a clinical team or management of a healthcare organization.

Mentorship

A relationship established between a leader or superior and a subordinate or trainee, characterized by a close, and typically enduring, pedagogical exchange, where the subordinate or trainee learns by observing and regularly communicating with the leader or superior.

Evaluation

The systematic collection of information about the activities, characteristics, and outcomes of programs, services, policies, or processes, in order to make judgments about the program/process, improve effectiveness, and/or inform decisions about future development.

Audit

The official inspection of a division, department, or clinician group, typically by an independent body. An audit is differentiated from more conventional evaluations carried out by an organization during the normal course of operations.

Regulatory or Legislative Standards

Statutes or principles established and enforced by an agency external to the medical profession. Regulatory or legislative standards are here distinguished from guidelines insofar as these standards are binding, often based on law or remuneration structures, and are outside the control of health organizations.

Legal

Established statutes outlining the prerogatives and responsibilities of medical professionals, organizations, and the rights of patients.

Societal Influences

The general level of social knowledge and attitude as it regards to a particular clinical behavior or procedure. For example, widespread attitudes about organ donation, or a public reaction to a hospital audit as it has been portrayed in the media.

Societal influences

The general level of social knowledge and attitude as it regards to a particular clinical behavior or procedure. For example, widespread attitudes about organ donation, or a public reaction to a hospital audit as it has been portrayed in the media.