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Table 2 Facilitators identified in the QICs mapped to the CFIR domains and constructs

From: The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review

CFIR domain CFIR construct Facilitators Refs Reliability of findings based on MMAT
Intervention characteristics Adaptability QIC participation highlighted possibilities for using the approach for other aspects of stroke care and other clinical conditions. [31, 34] Medium
Complexity Processes of care within a geographical area or where a specific team in responsible may be more susceptible to improvement using a QIC. [21, 23] Medium
Outer setting Patient needs and resources Greater patient feedback may change staff perceptions of improvement being more than just a ‘tick-box exercise’. [27] High
Cosmopolitanism Collaborative action facilitates the exchange of ideas, best practice, and experience. [28, 33, 36, 39] Low-high
Collaborative action fosters relationships between groups, improving cooperation and an emphasis on achieving results. [28, 29, 33, 39] Low-high
External policy and incentives External factors such as national level efforts during the QIC can influence the level of success achieved by using this approach. [23, 26, 29, 38] Medium-high
Inner setting Structural characteristics Stroke teams that function well may be associated with well organised stroke services and successful QI. [28, 37] Low-medium
Teams composed of professionals and management may be more effective at implementing successful improvements and making decisions. [28, 37] Low-medium
Networks and communications Communication of the QIC to the organisation fosters support, provides networking opportunities, and enables change. [27,28,29, 33, 35] Low-high
Culture Longer serving members of staff may be more positive towards innovation. [27] High
Implementation climate: Compatibility Resolutions for solving issues related to implementation include assigning responsibility to a named individual, establishing accountability, and devising new workable processes. [34, 39] Low-high
Positive baseline performance for acute stroke care may be associated with positive QI outcomes. [23] Medium
Implementation climate: Relative priority Identifying shared agenda and goals can unite QIC teams and help to find solutions. [39, 40] High
Implementation climate: Organisational incentives and rewards Motivation for change can be encouraged by organisation recognising activities undertaken by stroke teams. [39] High
Implementation climate: Goals and feedback Clinical feedback to staff is helpful for fostering successful QI. [23, 30, 31, 33, 35, 39] Low-high
Positive feedback mechanisms include annotated control charts, provider prompts (checklists), storyboards and knowledge translation strategies. [23, 30, 31, 33, 35, 39] Low-high
Focusing on essential topics and specifying aims if both necessary and helpful for achieving improvement results within a limited timeframe. [28, 39] Low-high
Implementation climate: Learning climate Learning sessions motivate change through opportunities to share and learn best practices and become familiar with QI tools. [33, 39] Medium-high
Access to teaching from experts facilitates improvement. [35, 36] Low-medium
Improving the content and accessibility of learning sessions may increase QIC participation. [28,29,30] Low-high
Readiness for implementation: Leadership engagement Involving and engaging senior leaders in the QIC and communicating progress to them is associated with improvement. [27,28,29, 31, 35, 39] Low-high
Readiness for implementation: Available resources Realistic time and resources for services should be provided for improvements to be achieved. [31, 35, 40] Low-high
Recording staff time spent and resources used on improvement activities can be used to assess cost-effectiveness. [25] Medium
Readiness for implementation: Access to knowledge Access to useful information empowers teams to develop greater knowledge of best practice, patient care and QI methods and enables the appropriate induction of new staff. [25, 28, 31, 33, 35, 40] Low-high
Stroke services with less knowledge and experience of QI may be more amenable to the approaches employed in a QIC. [37] Medium
Individual characteristics Knowledge and beliefs about the intervention Engagement with staff helps to foster a positive attitude towards changes implemented from the collaborative. [27, 31] Medium-high
Self-efficacy When staff understand the value of a QIC for improving patient care, it is a motivator for change. [31, 39] Medium-high
Individual identification with organisation The opportunity to work with other organisations and see what they are doing is a motivator for change. [39] High
Other personal attributes Individual or team characteristics have an impact on levels of enthusiasm and motivation. [28] High
Process Engaging: Champions Engaging and stimulating teams throughout the QIC is essential in encouraging improvements for patient care. [27,28,29, 31, 39] Low-high
Interacting with leaders in meetings provides opportunities to discuss care and facilitates clinical engagement in QI activities. [35] High
Engaging: external change agents External facilitators empower teams to take ownership of the changes and provide support to clinicians on how best to navigate changes across services. [40] High
Executing Best practice examples were adopted by participating hospitals and may mediate improvements. [34, 36] Medium
Consistency in employing the QIC approach and team participation, considering sustainability of changes, may support continued improvement. [28, 29, 35] Low-high
A structured project approach, focusing on measurable outcomes, stimulates action and efficiency in stroke care. [25, 28] Low-medium
Reflecting and evaluating Monthly monitoring data encourages teams to reflect on their current practice, celebrate success and identify areas for improvement. [39] High