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Table 6 Qualitative content analysis of key informant interviews—inner setting domain of the consolidated framework for implementation research

From: Intervention, individual, and contextual determinants to high adherence to structured family-centered rounds: a national multi-site mixed methods study

Inner setting domain qualitative content analysis themes

Facilitators

Construct

 Structured FCR approaches like I-PASS SCORE align with the values and culture of the organization

Culture

 Leadership support for structured FCR is strong with physician, nurse and patient experience leaders

Leadership support

Barriers

 Sites stopped doing certain structured FCR components in response to the COVID-19 pandemic

Implementation climate

 Lack of standardization in approach despite the presence of a structured FCR approach like I-PASS SCORE across attendings

Compatibility

 Subspecialists often make care plans without including the rest of the patient care team

Networks and communications

 Nurse participation on rounds is often subject to availability and competing patient priorities during rounding times

Compatibility

 Structured FCR approaches like I-PASS SCORE disrupt existing clinical workflows requiring redesign, particularly for nurses

Compatibility

 Nurse staff not properly resourced to support structured FCR approaches like I-PASS SCORE

Available resources

 Nurses utilize workaround methods to accomplish the goals of structured FCR while limiting their time participating

Compatibility

 Ongoing schedule changes lead to regular adjustments in team composition that impact rounding team development and performance

Compatibility

 Rounding schedules may not allow families to attend rounds

Compatibility

 Lack of resources as well as cultural barriers limit participation of limited English proficient families during rounds

Available resources

  1. List of frequent or compelling inner setting determinants identified through field interview to organization implementation of a structured FCR approach