Table 4.

Barriers and constraints related to implementation and sustainability of WTMS experienced by workshop participants (new factors in bold)

	Implementation		Sustainability
	Local level	Contextual level	Local level	Contextual level
Governance	• Lack of coordination among provider groups	• Limited information sharing	• Lack of management of critical diagnostic, surgical and continuity of care interdependencies	• Limited information sharing
	• Limited information sharing	• Competing health system priorities	• Lack of time allotted to WTM strategies	• Competing health system priorities
	• Lack of leadership for solutions	• Lack of leadership for solutions	• Limited information sharing	• Lack of shared learning opportunities among jurisdictions
			• Lack of clinical-administrative partnerships
Culture	• Competing cultures	• Lack of systematic approach to implement culture change	• Prevalence of a ‘blitz mentality’ among healthcare innovators	--------
	• Lack of evidence about value of WTM strategies	• Resistance to change and uncertainty
	• Resistance to change and uncertainty
Resources	• Lack of incentives (physician payment systems)	• Incentives (physician payment systems)	--------	• Lack of funding
	• Insufficient number of administrative staff	• Lack of funding
Tools	• Poor resourcing of technology and staff	• Lack of standardized data	---------	---------
	• Lack of change management support and tools