Table 4 Mechanisms
From: The influence of contextual factors on healthcare quality improvement initiatives: a realist review
Initial programme theory mechanism | Refined programme theory mechanism | Response triggered by intervention | System level influence |
|---|---|---|---|
Creating the Culture | Empowerment | Staff with autonomy to initiate improvement and come up with ideas/solutions; increases their desire to become involved. | Organisational structures to support autonomy. |
Ownership | Ownership of QI drives improvement activities. | Micro level—operational context (ward/clinic) where change takes place. Macro/meso level—organisational ownership, engaging with national initiatives and being able to translate them to local priorities. | |
Frontline engagement | Engagement | Engagement with QI efforts fostered by interest, active involvement and autonomy. | Needs micro/meso/macro level commitment. |
Informed practitioners | QI capability building | Micro level—empowers frontline staff to lead initiative and increased confidence show/tell other staff. | Needs micro/meso/macro level commitment. |
QI capacity building | Micro level—enabling via the provision of resources and support: building skills, knowledge, relationships and the confidence to enact change. | Needs micro/meso/macro level commitment. | |
Strong leadership | Psychological ‘safety’ | Micro level—freedom to voice concerns; characterised by openness, trust and open communication. | Organisational macro/meso structures to facilitate that psychological safety within QI work. |
Motivation | Micro level—motivation of staff. | Macro/meso level support for improvement. |