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Table 4 Summary of belief statements classified as barriers OR 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
There are (no) credible guidelines or algorithms for trauma patients at the hospital which improve patient care 10 I think they’re still work in progress. (Consultant)
No belief statements
Social/Professional Role and Identity
I do (not) see trauma as a large part of my role 10 A huge part of my role, it’s exactly why I chose to do emergency medicine, it’s exactly what interests me, um, and without the possibility of seeing major trauma I probably wouldn’t choose to do emergency medicine. (Registrar)
Management and politicians play a positive/negative role in steering the trauma service 8 I think, um, from management levels, I’m not sure how, I get a feeling there’s reluctance but I don’t know if that is, is true or not. (Registrar)
Beliefs about Capabilities
I am (not) capable of aspects of my own role in looking after trauma patients 9 I think I would have the skills, yeah. And confidence, and that confidence will only get better the more you see. (Registrar)
We do (not) provide good care as a hospital for the current caseload of trauma patients at present 9 …that’s [patients remaining in resus for prolonged periods of time], actually that’s, for me that’s a marker of a system that isn’t working, that isn’t getting the patient to their care, definitive care location. Um, and having, um, system-wide ownership of that patient. (Consultant)
My colleagues are (not) capable of adequately providing trauma care 7 I am very confident of my orthopedic colleagues, because we have a very good orthopedic department, and uh, the reputation of their trauma training is quite good. So I have no hesitation about, uh, my orthopedic colleagues with whom I work. (Consultant)
I’m optimistic/pessimistic about the changes being made and the role of major trauma at the hospital 10 I, I’m highly confident that we can. I’m highly confident that we could do it. (Manager)
My optimism/pessimism is conditional upon availability of necessary resources 4 …if we had everything that I’ve just described to you, plus the authority to make it happen, I reckon we could probably have it up and running by this time next year. (Consultant)
Beliefs about Consequences
Becoming a trauma center would affect the effectiveness of myself, my colleagues or the hospital in a positive/negative manner 10 …well to a large extent, because not only would we meet the needs of patients who are suffering from major trauma, much more effectively, uh, but we’d, I believe that developing [this hospital] into a major trauma service will improve the efficiency, the clinical efficiency of the hospital as a whole. (Manager)
Becoming a MTC would (not) influence patient views of their care 10 Um, I hope so. I think, uh, I guess it’s interesting, I mean there’s so much of this on telly now. I hope the public start asking questions about, you know, how we organize it and…I think their expectations ought to be a little bit different now. (Consultant)
I am (not) aware of any material rewards for becoming a trauma center 10 Hopefully if we were a major trauma center we’d get a bit more funding as well to, to expand our roles. (Registrar)
I am (not) planning to change the way either I or the hospital care for trauma patients 9 We are just now, we’ve decided to do this slightly differently, so we’re gonna have a group of four, we should come back to this action, we’re gonna have a group of four and we’re gonna meet probably every six to eight weeks, and that is one from ED, one from anesthetics, one’s from orthopedics and one from general surgery. Um, a, to look at the cases that are highlighted, cos although we're currently doing it, it‘s not being done with all four specialties, so we’re, that’s starting next month. Uh, to highlight those again, to take to the multi-disciplinary meetings. (Consultant)
We are (not) intending to contribute more towards resources and staffing to support trauma care and the transition to a MTC 6 We do have a, uh, another proposal for a coordinated hospital trauma response, and it’s good to go, and it’s gonna have to happen because of, um, changes that are happening within the emergency department, it is going to have to happen, um, so the timing around major trauma center is, is good from that perspective. (Consultant)
Motivation and Goals
I do (not) know about goals for developing trauma services 10 …then I guess having that, if we all know what the, what our timelines are…that becomes the end point…it then becomes just A to Z, and it within the timescale. (Manager)
Achieving goals depends on the motivation of those involved, which is positive/negative 10 It’s gonna be hard work to move the agenda forward unless they all realise how important a trauma agenda is for the whole of [local health board] and the whole of [this part of Scotland], not only trauma patients, because otherwise we’ll be a [district general hospital]. (Consultant)
Departments and individuals have a high/low motivation for trauma care 8 Yeah, timeliness, attendance…essentially it was because the leadership of surgery didn’t buy into this as a concept. And that’s still the position. (Consultant)
Our service is affected positively/negatively by targets and goals imposed from government level 7 Whereas the vast majority of targets which are used as a stick if you like, to beat, a, uh, NHS board with, or indeed to allocate reward, are based upon elective waiting lists, rather than outcomes, and specifically outcomes of unscheduled care, which I think are, uh, very much the poor cousin. (Consultant)
Memory, Attention and Decision Processes
No belief statements
Environmental Context and Resources
The hospital’s current trauma care and the transition to a MTC is affected by – and affects – the surrounding environment in a positive/negative manner 10 …because that’s essential, because we require the, uh, activity from the, uh, the major, from the [local health boards], um, to come to [this hospital], because we will always be marginal in terms of activity, uh, in relation to major trauma. (Manager)
The organizational culture at the hospital is (not) supportive and geared towards performance improvement 9 The greatest strength we have is that a very, very personal and not very formal or bureaucratic approach to team working. We can go to any colleagues without formal appointment and going through a secretary and this and that. And just knock the door and say, ’[xxx], can I discuss a case with you?‘ or, ’Can you help me?'. (Consultant)
Recruitment is difficult for the hospital, and may be made easier/harder by (not) becoming a MTC 7 If we didn’t have that, I think we’d lose a lot of folk…I probably would want to go to a major trauma center and work myself. (Registrar)
Social Influences
My practice is (not) influenced by guidelines and protocols 8 I don’t know if they [guidelines] would make a difference or not, but if there was evidence that it would then I’d be all for it. (Registrar)
I do (not) get affected emotionally by providing major trauma care 10 But my prime frustration in managing major trauma is not making things happen that I know needed to, to happen, in terms of organizing a response from, from specialties within this hospital. (Consultant)
Emotions do (not) affect the care I provide 5 No. When you’re highly charged, I think you give the best care, and I wouldn't say there’s any time where I’ve been worried that my staff can't look after a patient. (Registrar)
Behavioral Regulation
We (do not) currently have local and national auditing, monitoring and reporting procedures 10 I guess for the medical staff there’s the M and M meetings, but for us, as nurses there’s not really any formal recording (Nurse)