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

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.