Table 2 Qualitative themes associated with CFIR domains and constructs and illustrative quotations
Themes | CFIR Domain | CFIR Constructs | Illustrative Quote |
|---|---|---|---|
SFA Implementation Facilitators | |||
Organizational Context (e.g., leadership buy-in) | Individuals | High-level leaders, Opinion leaders | “I also think it was very valuable to have the leaders understanding what the training was about, so that I have their buy in and their support and they can come to the meetings, listen, help their caregivers understand, and then be able to utilize the tools in their department.” -Site Champion, Hospital |
Inner Setting | Mission Alignment | ||
Practical Factors (e.g., protected time) | Inner Setting | Available Resources, Relative Priority | “…they blocked the [HCWs] schedules off…. from 11:45 to 1:15. So we had our training from 12 to 1 until everyone was able to be there. There were no excuses like you know I have patients and stuff like that scheduled…. So it was good. I went through the training.” -Site Champion, Health Center |
Incentives | Inner Setting | Incentive Systems | “There’s a lot of employees in the ER, it’s the largest department in all hospitals…Sometimes… bribery is the best way of getting friends to come and participate. So in my little welcome packet…[were] …some stickers and [a] goofy ink pen and a chill pill which was a stress ball, that was the shape of a pill…like I said just, a little bribery doesn’t hurt.” -Site Champion, Hospital |
Site Champion Teams | Inner Setting | Structural Characteristics, Relational Connections | “So I facilitated along with [LEADERS] for the virtual setting. And I think the nice thing about that was it was split between the three of us, so there was a bit more comfort that like, if I’m forgetting something, I have two other co facilitators that can help me out and jump in if needed.” -Site Champion, Health Center |
Individuals | Implementation Team Members | ||
Implementation | Assessing Needs, Engaging, Teaming | ||
SFA Implementation Barriers | |||
Negative Perception of SFA Training and Materials | Inner Setting | Structural Characteristics, Available Resources, Access to Knowledge & Information | “…. when I looked at the [SFA training] content, I had no idea how to try to adapt it to my setting. It seemed quite dry to me, and it was like, I have the book somewhere around here and it was like, do this thing, do this thing, do this thing and I tried to use some examples…it was almost academic.” -Site Champion, Health Center |
Implementation | Planning, Tailoring Strategies | ||
Time-Related Constraints (e.g., time commitment to be a site champion, scheduling difficulties) | Inner Setting | Available Resources, Compatibility, Structural Characteristics, Relative Priority | “…although we absolutely had commitment of our organization to this process, just by nature of the work that we do and the amount of work that we have to do and the fact that our work is right in front of us: there are patients there, trying to plan the timing, trying to make sure that this is not just another thing that the team needs to do and try to fit it in with everything else they have to do … I think was difficult… I think it may have added a little bit of stress. Stress first aid may have added a little bit of stress in some cases.” -Site Champion, Health Center |
Individuals | Opportunity | ||
Pandemic-Related Factors | Outer Setting | Critical Incidents, Local Attitudes, Local Conditions | “…we had to pause a few times because of hospital numbers going up with there being another surge throughout the course. So I think, just the challenges of consistency are really hard in the inpatient setting while the pandemic continues…. the effort was more so in the coordination in such a large hospital setting, where people have such varying demands.” -Site Champion, Hospital |
Experience and Feedback on Implementing SFA Components | |||
Implementation Processes Varied Widely | Inner Setting | Culture, Compatibility | “We have a weekly all clinic meeting that is technically mandatory and is supposed to have everyone present that can be. And so I did the initial training’s in that full clinic meeting to try to get all as many residents and faculty members as possible.” -Site Champion, Hospital “So we went through the PowerPoint set by staff. We had different scenarios that we gave to the staff. How would they handle certain situations? And then at the end of every something like I said we would do I download it like a little relaxation yoga video with some music playing and allowed everyone to relax.” -Site Champion, Health Center |
Implementation Process | Assessing Needs, Planning, Engaging, Executing | ||
Antecedent Assessments | Implementation Climate, Implementation Readiness | ||
Sustainability of SFA | |||
Conditional with SFA Sustainability | Implementation Outcomes | Anticipated Implementation Outcomes | “Yes [I would advocate for the continuation of SFA], but [I] would want more structure and time. Because the lack of time, at some points, it felt like a burden to do that and we had to reschedule patients and find a space. If it’s more organized and we actually had [it] incorporated in our time, it would be actually a really good tool.” -Site Champion, Health Center |
SFA Sustainability Likely | “Yeah I would [advocate for the continuation of SFA] and I think to make it work really well, I would have to do everybody in the whole hospital. Which maybe I got third of them.” -Site Champion, Hospital | ||
SFA Sustainability Unlikely | “But for me… and I don’t know if there’s maybe resources available, but what do we do for staff now after we did our booster session and then what do we do with new staff? Like what happens? And I think that’s where I find challenging because we did all of this and okay, now what?” -Site Champion, Health Center | ||
Impact of SFA on HCW Well-Being and Organization | |||
Positive Impact on HCW Well-Being and Organization | Innovation Outcomes | Innovation Recipient Impact | “…probably one of the things I like best about stress first aid is you need to watch your people that you’re working with, get the cues from them. Do they look stressed? Ask them if they’re okay. People liked having the permission to do that, you know?” -Site Champion, Hospital |
Better Quality of Patient Care | Innovation Outcomes | Innovation Recipient Impact, Key-Decision Maker (or System) Impact | “So, I think when we start addressing caregiver stress and burnout, it automatically translates to the bedside. Caregivers are stressed, burnt out, busy, overwhelmed – that impacts patient care every day. We have seen an increase in our patient satisfaction scores over the last eight months in our emergency department. So, we’ve been watching… all the initiative we’ve been doing with staff, recognizing that we need to take care of our caregivers…. We’ve been watching our patient satisfaction scores increase. So, I would say that stress first aid was a huge impact on the care for the patients because now our staff are the better version of themselves at the patient’s bedside.” -Site Champion, Hospital |