Table 4 Identified facilitators and barriers

Influential individuals

Characteristics of individuals in local core SUSP team

The personal commitment and motivation of the individuals primarily responsible for implementing the SUSP intervention

Boundary spanners

The involvement of individuals who have multiple roles and traverse institutional boundaries to accelerate change and gain broad stakeholder engagement

Active leadership support

Individuals in leadership positions demonstrating their support for the project through their physical presence and making resources available

Peer-to-peer learning across participating hospitals

Hospital networking and positive deviance

Opportunities throughout the project to exchange in-person or virtually with individuals from other hospitals and learn from examples of positive deviance

Implementation fitness

Momentum

Building on the energy that was already channelled towards quality improvement thanks to previous projects

Enabling infrastructures

Benefitting from knowledge, surveillance systems, and practices already in place because of previous quality improvement initiatives was a foundation to support the introduction of new practices

Timely feedback

Tension for change

The feedback of sub-optimal baseline data showing room for improvement to create a sense of urgency to change practice

Ongoing feedback

Regular feedback of infection rates and process indicators throughout the project to sustain engagement

Organisational constipators

Lack of leadership support that stifles the efforts of other individuals to effect change

Workload

The significant SUSP workload was often taken on by SUSP core team members in addition to their pre-existing duties

Mistrust

Lack of financial incentives in the current project, as had come to be expected in previous projects, led to scepticism

Staff turnover

The rapid turnover of surgical staff created difficulties to keep everyone trained on SUSP protocols