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Table 3 Summary of belief statements classified as enablers

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
I keep up to date with evidence for major trauma care 9 …certainly more so recently. Uh, because of the, the development. (Manager)
I know about trauma care and how to manage trauma patients 5 I think the basics of the, the skills and knowledge, um, that are required for the management of major, major trauma patients, are very much established in, in what we do in critical care. (Consultant)
Skills
There are sufficient levels of the necessary non-technical skills at the hospital to provide major trauma care 8 I think I’m a good communicator, I get on really well with the staff here. (Registrar)
We can improve our care by learning skills from others both within and outwith trauma 7 Some surgical procedures and, I think that the, it would be of benefit for us to see how it is done elsewhere. (Consultant)
Skills in major trauma care would be better if the hospital were to become an established MTC 7 I think that for trainees, I think it would be hugely useful, I think the experience they would gain from it, I think the decision-making skills, I think the technical skills, um, I think um, I think that that would be fantastic… (Registrar)
Managing trauma patients is routine 7 Yeah. Yeah. I mean, well obviously all the staff are trained up on spinal injuries and, and major injuries like that. They are routine. (Nurse)
Social/Professional Role and Identity
I should play a role in the transition to major trauma center 8 I now see it as quite a large part of my role, the, uh, because the development of [this hospital] as a major trauma center is regarded as a high priority by the board. (Manager)
I should play a role in the initial assessment and resuscitation of the patient 6 I think [surgeons] should be involved from the outset when they arrive in hospital, um, and I think they should be involved in the decision making for that patient. (Registrar)
Someone should lead and coordinate the care of trauma patients through hospital 5 I think that that would ideally work best because the ownership for the care of that patient would be coordinated by one member or one team, um, which would make it I think much easier to manage them (Registrar)
Beliefs about Capabilities
We are capable of improving our practice and changing our culture to become a MTC, though it may be difficult in places 9 Well I think the institution of an appropriate group trauma call system. I don’t think that would take very long to, to, um, plan and implement, decide who you need, and then simply get a standard call system for that (Consultant)
Optimism
No belief statements
Beliefs about Consequences
Becoming a trauma center would lead to better patient care (more resources, higher priority, more patients, better recruitment) 10 I think the benefits are that we, that we can, uh, build an infrastructure and an image around it which becomes attractive, um, to, to recruiting the best staff we can. So there’s a good reason to come here, because we’re a major trauma center. (Manager)
A co-ordinated approach to efficiently meeting and treating trauma patients would make outcomes better 4 I think that would be really useful because a lot of time is spent looking to see what bleep number is this, this and this, and that's very time-consuming. (Registrar)
Becoming a trauma center would improve staff morale 3 it will boost the morale of the staff employed here. They feel that they are doing something important, they feel valued. They will be able to work as a team, which will be further boost to their morale. (Consultant)
Reinforcement
No belief statements
Intentions
No belief statements
Motivation and Goals
I am motivated to be involved in the transition to MTC 10 I very much feel that we should become a major trauma center, I feel I am committed to doing whatever I could do to facilitate that process, and I would hope that that view is shared by other people. (Consultant)
We should aim to deliver our best care and improve on it 6 I think providing a great service to our patients, I think, um, is something that we should all strive for. (Registrar)
Goals related to trauma care should be a high priority 6 Major trauma care takes priority. First and foremost. (Registrar)
Memory, Attention and Decision Processes
No belief statements
Environmental Context and Resources
No belief statements
Social Influences
Good teamwork is important to the current and future care of trauma patients 10 …we work as a unit across the floor and help each other out… (Nurse)
Authority and support from leadership figures is important in the current and future care of trauma patients 8 At a cost of repetition, [anesthesiologist], [Emergency Room consultant], and [trauma surgeon] I believe are the leaders who are driving this forward. And we will be swinging on their tail, as they say. (Consultant)
Knowing your colleagues well and understanding their strengths and limitations in an established team improves patient care 7 [this city] is still fairly small, very large village, where everyone knows everyone, they all know me when I arrive on the scene… (Consultant)
We need to work together with national and regional health bodies and outside organizations when planning the transition to MTC 4 it will allow us to develop really, it provides a stimulus for us to develop good relationships with our, [local health boards], uh, to, uh, attract the activity from the [region of Scotland]. (Manager)
Emotions
No belief statements
Behavioral Regulation
No belief statements