Table 2.

Exemplary Quotations

Coherence
The intervention wasn’t clear in the hospital because it was a new way of working. People knew the responsibility was training, but the facilitators thought they were there to make sure the standards were met, not to train the teams or anything else. They didn’t help with training. (I14, H2)
The intervention didn’t add much work. It just made us pay more attention to the same things. It didn’t change anything because it was already part of the work. We check lab results every day, and residents always check positive cultures. (I11, H1)
Cognitive participation
You need people ready to get involved and invest time on the study, which can often be the trickiest part. The coordinators from both hospitals met every week to discuss the project. Not everyone wants to do that. Despite the incentives, there’s no reasonable payment to encourage participation. (I10, H1)
Getting the team together and working in the same place is hard. It’s also hard to have a formal space for academic discussions. We’re always busy with urgent tasks. (I3, H1)
Collective action
Interactional workability
The infectious diseases department was the most helpful. They insisted that everyone follow the guidelines. The infectious diseases team believed in this and made it happen. (I10, H1)
We always used Ceftriaxone first, but we stopped because it causes a lot of resistance. We started using a different antibiotic that is less likely to cause resistance. That cost, I won’t deny it, but we didn’t kill anyone. Everyone said everyone would die or get infected. It was an important move. (I11, H1)
The time-out was on a spreadsheet. We reviewed the decisions daily, checking if they needed to be sustained, if there were any changes, or if the antibiotics needed to be withdrawn. A spreadsheet was used to record this during the study. It was hard to keep using this form long-term, even though the procedures were well integrated. (I3, H1)
Relational integration
The antibiotic regimen was different, which made it difficult at first. Many people were afraid because they were used to prescribing more antibiotics. Using fewer antibiotics could harm the patient. This was the biggest negative. (I2, H2)
We improved teamwork by involving the microbiologist and pharmacist in sharing results. We worked together to quickly adapt treatments and get good results for the patient. (I8, H1)
Skill set workability
People knew the responsibility was training, but the facilitators thought they were there to make sure the standards were met, not to train the teams or anything else. They didn’t help with training. (I14, H2)
The project also created something that I, as a manager, don’t think is beneficial. When you add lots of rules and algorithms, it’s suitable for doctors in training. However, for experienced professionals, it limits their autonomy. (I11, H1)
Evidence is essential, but experience is also helpful. It’s good to have a guide, but we also need to be able to adapt it when things don’t go as planned. You need to be able to see the exception. (I2, H2)
Contextual integration
The hospital didn’t take part in the study. Some people did. I know this from therapy, neonatology and infectious diseases. We are the only hospital ward. The inpatient wards function as a whole, so it is challenging to modify treatments at the weekend or if we are not there. Other staff are not trained, and doctors are on duty for all the wards. (I 7, H1)
The lack of coordination in the hospital was a problem. Some services did not participate, so they gave the ward an antibiotic that was not in line with the new guidelines. It had to be changed in the ward. From an ethical point of view, the new guidelines should be applied in all services. (I12, H2)
Monitoring
Any institution should have up-to-date antimicrobial treatment guidelines. The biggest achievement was updated guidelines. (I10, H1)

H, hospital; I, interview.