Table 4

Participant quotes by theme to illustrate barriers and facilitators

Interdisciplinary collaboration and accountabilityWe did collaborate with our obstetric group to say these are our standards and these are our clinical indications for inductions…So it’s become a very good collaboration between nursing staff, team leaders, triage nurses, as well as myself (manager). The long-term plan for this is to move it away from myself and move it to the team leaders and then to the triage nurses so that it has a sustainable approach to it moving forward. (Q1:P+/E+, Site N)It’s hard to quantify whose numbers they are, who the patient belongs to. So you have patients that you see in your office and you make plans for their labour and delivery or C-section, etc. and those are your patients from the office. But then when you’re on call, you react to what comes in the door. And so it’s a bit tricky to own any stats because you’re being given the information based on how you perform when you’re on call. (Q3:P-/E+, Site M)
Application of formal change strategiesThis is the first organization I’d been in who has really engaged in [name of change framework] from boardroom to bedside and that’s extremely important. The concept of [name of change framework] is a philosophy. It’s a performance management methodology that really transforms your culture. (Q1:P+/E+, Site B)Well, it’s (the process) a bit random, to be quite honest…I can’t recall having a discussion to say, okay, here’s our KPIs, here’s how we’re doing, let’s decide—this is going to be a goal for the next year. We haven’t had those conversations, so that’s why I say it’s a bit random. (Q2:P+/E-, Site A)
Team trust and use of evidence and dataIf you start at the beginning, they trust the process on how they get the data in, right?… They understand that the nurse looking after the patient is the right person to enter the data accurately…They trust the (registry) data quality reports that they use… and they trust the Dashboard in that there is a mechanism in the Dashboard to drill down into it. They’re able to do a little audit and through that process, make changes if need be but also when everything comes up and it’s all been entered accurately by chart audit, they trust the Dashboard. So all of those things have built up a trust and it didn’t come overnight, right? (Q1:P+/E+, Site D)When it looked like we were going to look at it (the Dashboard data) more seriously, then came the questions. Well how do I believe you? I see how the data is entered. I don’t really have confidence in the data. So you could call it red. You could call it purple, it doesn’t really mean anything. (Q4:P-/E-, Site J)
Alignment with organisational priorities and supportOur induction strategy became a priority for two reasons. Number one, because we were performing poorly on the metric (KPI 6), but number two, it was significantly affecting our patient flow and our clinical flow because our inductions were very much unregulated. Some days we would have nine, other days we’d have zero, which is very hard because of staffing issues that we were facing at the time. So it (KPI 6) became a programme priority. (Q1:P+/E+, Site N)This may sound like an excuse, but we are a smaller centre and we don’t have the availability of operating room time perhaps quite as frequently as a tertiary care centre or a much larger centre that has many more operating rooms and many more anaesthetists and so on. (Q2:P+/E-, Site A)
  • E, engagement with Dashboard; KPI, key performance indicator; P, performance on KPIs.