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Table 4 Identified facilitators and barriers

From: Implementation of a surgical unit-based safety programme in African hospitals: a multicentre qualitative study

Influential individuals Characteristics of individuals in local core SUSP team The personal commitment and motivation of the individuals primarily responsible for implementing the SUSP intervention
Boundary spanners The involvement of individuals who have multiple roles and traverse institutional boundaries to accelerate change and gain broad stakeholder engagement
Active leadership support Individuals in leadership positions demonstrating their support for the project through their physical presence and making resources available
Peer-to-peer learning across participating hospitals Hospital networking and positive deviance Opportunities throughout the project to exchange in-person or virtually with individuals from other hospitals and learn from examples of positive deviance
Implementation fitness Momentum Building on the energy that was already channelled towards quality improvement thanks to previous projects
Enabling infrastructures Benefitting from knowledge, surveillance systems, and practices already in place because of previous quality improvement initiatives was a foundation to support the introduction of new practices
Timely feedback Tension for change The feedback of sub-optimal baseline data showing room for improvement to create a sense of urgency to change practice
Ongoing feedback Regular feedback of infection rates and process indicators throughout the project to sustain engagement
  Organisational constipators Lack of leadership support that stifles the efforts of other individuals to effect change
Workload The significant SUSP workload was often taken on by SUSP core team members in addition to their pre-existing duties
Mistrust Lack of financial incentives in the current project, as had come to be expected in previous projects, led to scepticism
Staff turnover The rapid turnover of surgical staff created difficulties to keep everyone trained on SUSP protocols
  1. SUSP=Surgical Unit-Based Safety Programme