Volume 23 Supplement 2

London Trauma Conference 2014

Open Access

Identifying the barriers and facilitators to transforming a university hospital into a Major Trauma Centre: a qualitative case study using the Theoretical Domains Framework

  • Neil Roberts1Email author,
  • Fabiana Lorencatto2,
  • Joanna Manson1 and
  • Jan Jansen3
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201523(Suppl 2):A10

https://doi.org/10.1186/1757-7241-23-S2-A10

Published: 11 September 2015

Background

Scotland is currently implementing a trauma network with four Major Trauma Centres (MTCs). Transforming successful teaching hospitals in to MTCs is likely to generate various beliefs amongst staff. The Theoretical Domains Framework (TDF) is a tool to elicit and analyse beliefs [1]. This study applied the TDF to explore barriers/facilitators to MTC establishment.

Method

Semi-structured interviews were conducted with 10 participants from a single hospital prior to MTC designation including clinicians, nursing and management staff. A topic guide was designed using the TDF. Interview transcripts were analysed following a framework analysis approach and coded according to TDF domains. Themes were analysed for relevance according to prevalence, expressed importance, discordance and underlying evidence base.

Results

1728 utterances were coded into 98 themes, of which 57 were classified as relevant barriers/facilitators. Themes addressed 6 key areas: Beliefs towards becoming a MTC (e.g. My optimism/pessimism is conditional upon availability of necessary resources), resource demands (e.g. Recruitment is difficult, and may be affected by (not) becoming a MTC), current capability (e.g. Motivation for trauma varies between departments/individuals), knowledge/skill development (e.g. Maintaining skills is important, as is developing them), trauma teams and a structured trauma pathway (e.g. Someone should lead/coordinate care of trauma patients), and performance improvement processes (e.g. The organisational culture is (not) supportive and geared towards performance improvement).

Conclusions

This study identified a range of barriers and facilitators likely to influence the transition of this hospital into a MTC. Findings highlight a need for clear systems, processes, communication and teamwork, and delineate the complexity of participants’ motivation and optimism/pessimism. This provides a basis for developing targeted interventions to facilitate the implementation process. This is a replicable method of evidence-based service-improvement, which can be applied elsewhere throughout acute care.

Authors’ Affiliations

(1)
Barts Centre for Trauma Sciences, Blizard Institute, Queen Mary, University of London
(2)
Health Services Research and Management, School of Health Sciences, City University London
(3)
Department of Intensive Care, Aberdeen Royal Infirmary

References

  1. Cane J, et al: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Roberts et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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