Table 4

Illustrative interviewee quotations on organisational preconditions

PreconditionIllustrative interviewee quotations
1. Cultural readiness‘…we had already got enthusiastic individuals because we’d got people working in that system, we didn't have to persuade lots of people this was a reasonable thing to do, and so that's the fertile ground I think…' (C2—senior executive manager)
‘…A big focus in this organisation on improvement, on ‘we need to do better than we do already. This may be good, but how can it be better?’ So, I think there was definitely an attitude and a philosophy to do that…’ (G3—safety and risk leader)
2. Improvement track record‘…I think it did have quite a strong…improvement ethos… …So, there was a lot of improvement work going on…’ (MD2—senior clinical leader)
‘…I think the basic drivers of how to improve were there…in the previous 5 years…So, there was a bit of development there… I think the organisation was ready for it…’ (G3—safety and risk leader)
‘…we had already embarked on the patient safety journey…and some of the improvement work we were familiar with…So, I think we really viewed this as…the next big step that we need to take…’ (D2—senior nursing leader)
3. Adequacy of quality information systems and measurement processes‘…on another level, we were massively under prepared for SPI…when we launched into it, I think we found that our databases, our information collection systems weren't easily transferable into SPI, or we weren't collecting information at all…’ (C2—senior executive manager)
‘…people shouldn't underestimate the effort and time and complexity of generating reliable (process measurement) systems ’ (C3—senior executive manager)
‘…we struggled even then to do the baselines… the NHS Information Systems are so poor…’ (G1—clinical governance leader)
4. Financial stability and absence of serious failures to meet other targets‘…We've now been in financial balance for 6 years. We've met all of our waiting times targets for the last 6 years, we're about to do it for the seventh, and at that point of having sorted the thing out…once we'd uncluttered the mess, we started on an improvement journey…’ (C4—senior executive manager)
‘…we could concentrate on doing the SPI. Whereas I think if we'd…been worried about finances, etc, it would have, I think it would have taken us off on another direction. We were still struggling with the A&E wait, so on that target we were still, and we still continue to be, worried…’ (D2—senior nursing leader)