Table 3.

Strengths and concerns of each contextual factor

Contextual factor	Strength	Concern
RED as a Priority to Leadership	Leadership demonstrated buy-in by making RED an institutional priority. They also showed involvement, and support of RED implementation, and encouraged employees to embrace change, adaptation and creative solutions.	Leadership showed lack of focus on addressing readmissions and failure to commit adequate resources. There was also an absence of leadership involvement in RED implementation, and lack of guidance and direction from management.
Adaptation and Implementation strategy	Implementation strategy started with a purposeful planning period and careful deliberation on how to best implement RED. Adaptations maintained a high level of fidelity to the intention of the intervention.	Implementation strategy was unplanned, disorganized, and approached RED as a time-limited project. Focused on select elements of the RED toolkit, thereby failing to address critical aspects of the discharge process and inherently changing the possible impact of RED.
Implementation Team	Leadership selected an implementation team that had depth, was accountable, was multidisciplinary and had a dynamic leader who was able to effect change. Components of the RED toolkit were divided amongst enough individuals to delegate and distribute the workload, and where each person had a distinct role to play.	Implementation team lacked multidisciplinary input and representation; team often lacked the social capital and ability to influence others to be enthusiastic about RED implementation. Components of the RED were assigned in a manner that was burdensome to staff and lacked accountability.
Planning for Sustainability and Longevity	Forward-thinking planning to approach RED as a transformational process, rather than a project, with clear goals for integration into daily workflow.	Approached RED implementation as a grant-dependent project without consideration for sustainability of RED staff salary support or workflow integration of RED discharge process.
Hospital Culture	Positive hospital culture that embraced failures, fostered a feeling of empowerment for both employees and patients, and remained patient-centered. Leadership was supportive of implementation team, which promoted the feeling that chance was possible, fostering a spirit of continuous improvement.	Negative hospital culture that lead to employees holding defeatist attitudes towards their patient populations, felt helpless in effecting positive change in their environment, and failed to see discharge as a necessary area for improvement.