Table 3 Examples of resource-climate interactions at group 3 clinical sites

Technological support

Compatibility (integration of the dashboard into existing workflows and systems)

Technology (≈) → compatibility (↓)

The intervention was not able to be integrated into the daily schedule at the clinic. The interviewee suggested that they needed technological support to streamline the dashboard and other tools into one system

Implementation

“I think, we’re trying to right now work it into your daily schedule of what you’re doing would not work. Maybe if it was like part of our notes or as I said before, incorporated or integrated into our notes that we do, and at the same time I’m doing a note, I can be doing a dashboard thing, like if it was all kind of together in one, I don’t know how you’d do that, like in one program or something or if we could do a note through the dashboard that would… take everything off instead of doing it through CPRS or something maybe, but making it accessible and second nature to use, not like a separate work that you have to do on top of all the other junk that you’re doing”

Site 24, Study ID 136

Time

Compatibility

Time (↓) → compatibility (↓)

Time constraints throughout the course of implementation made it difficult to integrate the intervention into their workflows

Implementation and sustainment

“It’s not like, I don’t think it’s [dashboard] not helping, it’s not a tool, it’s just another thing to have to do and… I don’t need any more to do at this point. I’m not trying to diss, I know it’s a great idea, I sound like a slacker, but I’m really, I’m really not, I know it’s a great thing and it would be ideal if we could have it, working on it all the time but that doesn’t happen.”

Site 24, Study ID 136

Consistent support from implementation partners

The extent to which the use of the intervention was supported within their organization

Support (↓) → climate (↓)

Over time, the staff faced challenges working with physicians and felt the time they spent on the intervention was not valued and they could not make any influence on patient care through using the dashboard

Sustainment

“There are a lot of complaints about the notes I put in [sending notes too early] and there are a lot of times where the notes don’t even get signed. So, whether or not the Primary Care providers are really looking at these notes or really putting in renewals, a lot of the time they don’t. So, it’s almost like I’m wasting my time.”

Site 40, Study ID 169