RT Journal Article SR Electronic T1 Optimising impact and sustainability: a qualitative process evaluation of a complex intervention targeted at compassionate care JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 970 OP 977 DO 10.1136/bmjqs-2017-006702 VO 26 IS 12 A1 Bridges, Jackie A1 May, Carl A1 Fuller, Alison A1 Griffiths, Peter A1 Wigley, Wendy A1 Gould, Lisa A1 Barker, Hannah A1 Libberton, Paula YR 2017 UL http://qualitysafety.bmj.com/content/26/12/970.abstract AB Background Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery.Objectives To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings.Methods Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4).Results Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning.Conclusions Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability.