No of studies found reporting context | Two studies9 10 | Nine studies | Five studies11–15 | Two studies16 17 | Twenty-three studies18 |
Context factors reported to influence implementation or effectiveness | No 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.17 | Regulation (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 reported | Limited 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 implementation10 | Only a general description of context factors given in some other studies | The intervention may also change context (safety culture)15 | Several risk factors differentiated near misses from actual occurrences—reported many contexts that appear related16 | Most important context factors are related to the implementation process or the technical features of the computer physician order entry systems18 |