Table 5 Achieving integration and collective action: TDF and NPT in practice

The feedback reports enabled change by targeting gaps in knowledge around risky prescribing and anticoagulation (TDF knowledge); data illustrating the importance of the topic stimulated a belief that the work was valuable (TDF beliefs about consequences); the small numbers needed to treat enabled a sense of the work as achievable (TDF beliefs about capabilities and environmental context and resources). The intervention met a perceived need and outlined clear individual and communal expectations (NPT communal and individual specification) without replicating current practices (NPT differentiation).

The anticoagulation reports traded on appropriate expertise to encourage practices (TDF social influence); in risky prescribing, comparison with other practices stimulated competitiveness (TDF social influence). Those involved attending outreach meetings and reviewing reports were appropriate in terms of clear roles and skills to do the work (TDF social and professional roles and skills). This enabled staff to outline work needed quickly and efficiently, targeted at the right people (NPT initiation, enrolment, and legitimation). Staff worked together and had clear ideas of who did what (TDF social and professional roles; NPT interactional and skill-set workability).

Risky prescribing practices that repeated the searches saw the impact of their work (NPT systematisation). As the trial went on, positive feedback on achievement encouraged continued engagement (TDF motivation and emotions). Discussing this feedback enabled continued work (NPT activation), as well as reinforced a sense of how feasible and useful the work was in practice (NPT individual and communal appraisal).