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Table 2 Summary of belief statements classified as barriers

From: What helps or hinders the transformation from a major tertiary center to a major trauma center? Identifying barriers and enablers using the Theoretical Domains Framework

Belief statement (n = number of participants expressing the belief) n Example quote
Knowledge
Others have variable or limited knowledge of trauma 5 but the level of knowledge that people have of major trauma, of a major trauma center, and the implications of being a major trauma center, uh, are, are, are limited just now, but that’s, that’s what, something we’d need to work on (Manager)
I do not know what the resource requirements are for current trauma care or for becoming a MTC 4 I’m quite sure we don’t have the, the resources in terms of staffing and infrastructure, um, but I don’t know what those are yet, because we haven’t calculated that, but we’re just in the process of doing that. (Manager)
Skills
In general, there are not sufficient levels of the necessary technical skills at the hospital to provide major trauma care 10 I mean certainly I think experience is lacking, it is just one, uh, is one aspect, um, I think certain courses I think would be useful to do, but I think the fact that, um, I don’t see a huge number of trauma cases but I think my experience is much less of that than someone who is based at a trauma center at the moment. (Registrar)
There are not sufficient amounts of teaching and training in trauma care at the hospital 8 it would be much nicer if we, if we prioritized and nurses did have proper training. Things like the trauma, rather than how to clean a bed frame properly. (Nurse)
Maintaining skills is important as well as developing them 4 Um, trauma for those, because it doesn’t happen, a number of times every day, there is an issue of maintaining skill and making sure that folk are adequately prepared to be able to mount the right response when it is required. (Manager)
Social/Professional Role and Identity
No belief statements
Beliefs about Capabilities
Sometimes I require others to help me perform parts of my role in looking after major trauma patients 6 …one individual I think will never have either the skills or the ability to multi-task sufficiently to deal with all aspects of it, so, um, I can deal with, um, a given role, but the big thing is getting people with different skill sets involved… (Consultant)
Optimism
No belief statements
Beliefs about Consequences
No belief statements
Reinforcement
No belief statements
Intentions
No belief statements
Motivation and Goals
No belief statements
Memory, Attention and Decision Processes
There are numerous potential distracting priorities at the same time as trauma that do not allow me to do my job and impact on patient care 9 we’re so busy elsewhere dealing with cases that shouldn’t be coming through the emergency department in order to keep the department safe (Registrar)
Environmental Context and Resources
We (do not) currently have enough levels of resources to provide good trauma care 10 A lot of our patients, the physio and OT service, as I said, it’s priority of who’s getting, you know, seen, rather than everybody who should be seen is seen. (Nurse)
Substantially more staffing and resources, and maintenance of those already in place, would be required to effectively become a MTC 10 We would need to retain the speciality surgical services, such as cardiothoracic, such as neurosurgery, such as vascular… (Consultant)
The hospital is not organized in the optimum manner for trauma care and a reorganization would improve this 10 …ways of looking at how many people need to be on a trauma rota, so I don’t expect every general surgeon to want to do trauma, um, but if they are happy to facilitate a reasonable number to be on a rota to give that kind of level of response… (Consultant)
It’s not clear how much becoming a MTC will cost or benefit, and funding it may be difficult 8 If there are finite resources, and infinite demands, then somebody will have to make some compromises somewhere. And that’s what the managers and the financiers will have to look into. (Consultant)
Social Influences
There is variation amongst the views of myself and my colleagues about the transition to a MTC 9 [how committed are your colleagues to becoming a MTC?] The same. But they share my reservations, so, you know, there’s heaps of reservations along the way, but absolutely committed. Just wish we saw that level of commitment from, from everyone. (Consultant)
Management, nursing and medical staff do not work well together at present 3 a lot of the issues that surround us at the front lines, seem to be belittled or ignored by senior management. (Consultant)
Emotions
No belief statements
Behavioral Regulation
I do not attend local governance meetings 2 …I used to attend when I could, our M and M meeting you know, with the four consultants, but at the minute there’s like sixteen-odd consultants and growing more and more by the day, so, it’s difficult to attend and be part of that group and understand the, what’s coming back from that morbidity, you know, um, conversations that they have… (Nurse)