Table 6.
Stable high fidelity cluster (n = 9) | Moderate and improving fidelity cluster (n = 6) |
---|---|
Adoption period a | |
Organization’s starting positionb was high (n = 3), moderate (n = 4) or low (n = 2) | Organization’s starting position was high (n = 2) or low (n = 4) |
-The organizations (n = 2) with low starting positions improved within a short period | -The organizations (n = 4) with low start positions improved within a moderate to long period |
“They [professionals in one organizations] prepared the implementation [of the program] within 3–4 weeks. This illustrates their fast improving ambition levels.” [Quote from a program coordinator] |
“It was a very difficult starting process, because of the many staff-turnovers at management level.” [Quote from a program coordinator] |
Ambition level during adoption | Ambition level during adoption |
-High ambition level (n = 6) | -High ambition level (n = 2) |
-Ambition level was not discussed (n = 3) | -Moderate to low ambition level (n = 3) |
-Ambition level was not discussed (n = 1) | |
Implementation period a | |
Role of physicians | Role of physicians |
-Proactive role before the start (n = 4) -Active engagement during implementation (n = 9) |
-No or less active engagement before and during the implementation (n = 6) |
“In 2011, we presented our Handbook at a national meeting organized for rehabilitation physicians. Afterwards, he [a physician of a participating organization] came to me and said ‘I really want to have that Handbook, because I want to implement that program’ [RSE].” [Quote from a program coordinator] |
“It was a conscious choice. […] At the start of the project, we were in the middle of a re-organization. And during that time, we were understaffed. And we tried to involve a physician, but it didn’t worked out.” [Quote from a project leader and counselor] “We have to start a project, and none of the physicians had time [to be member of the work group]. […] And that’s why one of the physicians was involved from the background, as a sounding board for me. […] But nobody participates in the work group. [Quote from a project leader] |
Changes in organizations | Changes in organizations |
-The impact of staff turnover processes was not explicitly discussed during interviews (n = 9) | -Staff turnover processes delayed the implementation (n = 2) |
-Reorganizations took place (n = 1) | -Reorganizations took place (n = 3) |
Organization’s vision and strategy | Organization’s vision and strategy |
-The majority (n = 8) had an explicit vision and strategy about the implementation of the program | -The minority (n = 1) had an explicit vision and strategy about the implementation of the program. |
“They implemented a standardized group-based intake session [of the program]. At the start of the rehabilitation treatment, all patients receive a group-based intake session about sport and exercise opportunities.” [Quote from a program coordinator] |
“Eventually, I mainly used the Handbook [of the program] to write the project plan. [..]. That [Handbook] was a very useful tool.” [Quote from a project leader and counselor] |
Notes. aInformation about the adoption period is mainly derived from the interviews with the program coordinators. Information about the implementation period is derived from interviews with the program coordinators and involved professionals (project leaders, managers, and counselors). bOrganization’s starting position refers to the extent to which organizations had already implemented components of the program within their daily routines during the adoption period