Table 1

Summary of findings from reviewing evidence presented in studies of five patient safety practices

Falls in institutionsMedication reconciliation tool and process redesignPrevention of catheter-related bloodstream infectionsUniversal protocol for wrong site surgeryComputer physician order entry and computer decision support system
No of studies found reporting contextTwo studies9 10Nine studiesFive studies11–15Two studies16 17Twenty-three studies18
Context factors reported to influence implementation or effectivenessNo strong evidence either for or against context factors either helping or hindering implementation of falls interventions in institutions‘Blocking functions’ in electronic systems to increase compliance with medication reconciliation steps10
  • Leadership involvement, teamwork, nursing staff empowerment and interdisciplinary rounds, and training resources11

  • Barriers: insufficient time or resources, organisational and regulatory barriers, and lack of a quality improvement infrastructure within the organisation12

  • Involvement of hospital leadership, project leadership, quality improvement experience, education, and motivation13

  • Hand washing campaigns14

  • Safety culture19

  • Previous education, teamwork and culture interventions, and leadership, feedback and support of outside quality-improvement expertise15

Participation of the surgeon in preoperative verification, participation of all surgical team members in the ‘time out,’ and the surgeon explicitly empowering team members to speak up if concerned and acknowledging concerns when expressed.16 Strong correlation between technical error and teamwork failures.17Regulation (100% of the 23 studies reviewed), external incentives (100%), organisational size and type (100%), teamwork (74%), leadership (30%), culture (9%), training (61%), internal incentives (52%), audit and feedback (35%), and quality-improvement consultants (13%)
Other relevant evidence reportedLimited evidence that unit leadership may be important for implementing falls interventions successfully, and a positive safety culture is a helpful context factor, the absence of which can influence implementation10Only a general description of context factors given in some other studiesThe intervention may also change context (safety culture)15Several risk factors differentiated near misses from actual occurrences—reported many contexts that appear related16Most important context factors are related to the implementation process or the technical features of the computer physician order entry systems18