Health care transformation in a resource-limited environment: exploring the determinants of a good climate for change

Figures & data

Figure 1 Health care improvement project overview (updated).

Notes: The aim of the initiative was to improve the quality of health care through training of health care professionals in leadership skills and engaging in a health improvement activity, ie, develop a care pathway.

Table 1 Respondents’ demographics (n=10)

Variable	n=10
Gender
Male	4
Female	6
Professiona
Medical specialist	2
Nurse	3
Management staff	4
Paramedic	2

Note:

a One participant had two functions within the organization.

Table 2 Overview of the duration of interviews with the participants

Participants	Profession	Duration of interview (minutes)
P1	Nurse	33
P2	Paramedic	34
P3	Nurse/management	35
P4	Medical specialist	28
P5	Management staff	20
P6	Management staff	22
P7	Management staff	22
P8	Paramedic	25
P9	Medical specialist	7a
P10	Nurse	21

Note:

a This participant had an unexpected emergency to attend to and left prematurely for the operating theater.

Table 3 Matrix of the major themes and subthemes identified by participants

Context	Main theme	Subtheme	Participants who mentioned this
Underlying factors defining the implementation climate	Attitude of staff toward policy changes	Negative experiences in the past shaped current opinion	1, 3, 5, 6, 7, 8, 9, 10 (n=8)
		Fear for change	2, 3, 5, 7, 8, 9 (n=6)
		Stuck in daily routine	2, 3, 4, 5, 7, 8, 9, 10 (n=8)
	Vision of the organization	Unaware of the current vision	1, 2, 4, 8 (n=4)
		Lack of a long-term vision	1, 3, 6, 7, 9 (n=5)
		Vision of organization not aligned with personal vision	2, 3, 6, 7, 9 (n=5)
	Collaboration	Suboptimal collaboration with other disciplines	1, 2, 3, 4, 7, 8 (n=6)
		Suboptimal “vertical” collaboration	1, 3, 5, 6, 7, 9 (n=6)
		Collaboration used to perform evidence based practice	2, 3, 6, 8, 9 (n=5)
		Need for better multidisciplinary collaboration	1, 2, 3, 4, 8 (n=5)
	Transparency and communication	Not involved in decision-making process	1, 3, 5, 6, 7, 9, 10 (n=7)
		Bureaucratic procedures in place	2, 3, 4, 6, 9 (n=5)
		Loss of credibility	1, 6, 7, 10 (n=4)
	Personal development	Insufficient appreciation for work	1, 3, 6, 7 (n=4)
		Lack of training/educational opportunities	1, 2, 3, 7, 8, 10 (n=6)
	Resources	Human resources	1, 3, 4, 5, 6, 8, 10 (n=7)
		Physical structures (infrastructure)	1, 2, 3, 4, 9, 10 (n=6)
		Education	1, 2, 3, 8, 10 (n=5)
Potential effects and consequences	Loss of motivation		1, 5, 7, 9, 10 (n=5)
	Creativity		2, 3, 4, 9 (n=4)
	Us vs them		1, 3, 7, 9, 10 (n=5)
	Short-term solutions		1, 2, 4, 6, 9, 10 (n=6)
	Suspicion/frustration		1, 3, 4, 9, 10 (n=5)

Figure 2 Overview of the underlying factors, influencing the implementation climate and the perceived consequences of these factors.