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Table 5 Refined CMO configurations

From: Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation

Context Mechanism Outcome
Context 1: The prehospital work is accomplished a long distance from medical support; the personnel handle many different symptoms and conditions in changing environments and they have different levels of education and experience. Mechanism1: The guidelines are developed in a process in which people with in-depth context knowledge are excluded. Outcome 1: Guidelines with a format poorly adjusted to the context.
Outcome 2: Guidelines with limited explicit use.
Outcome 3: Development of homemade guidelines.
Outcome 4: Lack of organizational control.
Outcome 5. Explicit use of guidelines in file format creates a sense of unprofessionalism.
  Mechanism 2: Structured implementation strategy of the guidelines at local level. Outcome 1: The personnel are well informed of the guidelines and their content.
Outcome 2: The personnel take a positive view of the guidelines.
Outcome 3: Both inexperienced and experienced personnel use them.
Outcome 4: Improved team function.
Mechanism 3. Difficulty developing guidelines which cover every possible situation. Outcome 1: Deliberate deviation from guidelines.
Outcome 2: Ethical conflicts.
Mechanism 4: The ambulance mission is divided into 5 separate phases. Outcome 1: Different need for support in the different phases.
   Outcome 2: Request for a system which covers all phases.
  1. The table show the mechanisms embedded in the context and theirs effects on outcome.