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

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