Table 4

Illustrative quotations describing organisational setting at two hospitals

WhoIllustrative quote
Hospital C: highly connected setting
Infection control professional“We’re going to set a new bar…you have to push one another. Nobody’s going to sit back and be comfortable. You’re going to push one another to go to that next level because having value and feeling like you make a difference is what makes you in your work and that can just carry over…to the people in the areas you’re covering.”
“relationships you develop with people [are the most important facilitator for getting best practices implemented].”
Physician leaderThe Critical Care Medical Director actively demonstrated the importance of working together: “‘We’ is everybody involved in the care of the patient…I mean, the intensivist sees every patient every day with multidisciplinary round on patients every day. The nurses are part of this, we, the residents are part of this, we, the patients and people that touch the patient are part of the care of the patient.”
Executive teamThey conducted executive “walk-arounds” through units talking with staff; increasing visibility of the change effort and accessibility.
Nurses/physiciansNurses are included in multidisciplinary rounds of patients.
Hospital A: poorly connected setting
Quality manager“It sometimes can be very difficult to get people on the same definition of the mission…I mean, well ‘mission’ might come one or two below their own self interest…”
Physician leader“everyone thinks when they label you as a champion…‘oh, more work, more problems’…”
Respiratory therapistSome physicians have actively resisted new procedures: “physicians literally throw things back at me”
Nurse manager“let’s just say that there were some political issues between nursing service and a [physician leader]…basically it fell to myself and [another nurse] and the two of us did it all basically…if I keep off the radar, I can go do what I need to do, so that’s what I did…”