Table 3.

Thematic framework and subthemes identified.

Major themes title	Focus	Q1: How is the element supported, or not, in the current practice?		Q2: How will/could this element be used in the future?	a. What are key enablers?	b. What are key barriers?
		Supports (✓)	Does not support (×)
1. Organisational versus system focus	Structures support an organisational not system focus		× No system accountability × Funding method prescriptive × Planning not strategic × No team across the continuum × Lack of innovation and focus on the process of change	✓ Accountability for outcomes, joint key performance indicators (KPIs) ✓ Funding reform to allow flexibility and change ✓ Vision for a health system and long term strategy agreed ✓ Focus on care for the population and care across the continuum based on needs	+ Patient-focused care + Change supported, measured and evidence provided	– Short term strategy & policy cycles – Drivers - financial, political, and cultural - not aligned – No joint accountability for population health planning, performance or outcomes
	Access to quality and useful data across the system is essential		× Poor data quality × Data rich, information poor	✓ One central national repository for all data ✓ Needs to be broken down into geographical areas for use locally ✓ Data governance agreed	+ Sharing data across the continuum is key	– Lack of access to quality data – Legal issues – who owns the data, political risk, consent and privacy – Cost
2. Leadership and culture	Leadership skills to develop a ‘system’ approach is essential	✓ Goodwill at executive level ✓ See the need for change	× Lack of leadership, trust and commitment	✓ Boards have to operate in honest and transparent environment and value working in partnership ✓ Board’s commitment demonstrated with joint MOU to support structural alignment	+ Board agreement on common purpose + Determine priorities + Dedicated resources to facilitate under CEO direction	– Lack of leadership and commitment to change – No central co-ordination at government level
	Clinician engagement across the continuum is key	✓ Roles working across the continuum have brought change	× Lacking at senior level × Inadequate resources to support engagement	✓ Clinician leaders identified and supported to lead the way ✓ Use of boundary spanners	+ Clinician leadership - joint clinical governance board to agree protocols across the continuum + Facilitate communication, build goodwill	– Overcoming vested interests to keep things the way they are – Clinician leaders risk-adverse rather than allowed to be sensible risk takers
	Cultural barriers exist		× Risk-averse rather than risk-aware × Perceptions hospitals have the most to gain	✓ Value working together, mutual respect and understanding articulated throughout the sectors	+ Build relationships and professional respect	– Decades of bureaucratic control to overcome – ‘Master/servant’ relationship – Lack of communication and collaboration across the system before decisions are made
	Workforce capacity building is needed		× Seen as operational not strategic	✓ Support interprofessional learning opportunities ✓ Need a driver tasked with this – boundary spanner	+ Shared KPIs for outcomes + Requires strategic support + Requires strategic support	– How do we educate across the continuum? No KPIs for this
3. Community (dis) engagement	Overcoming perceptions		× Not using the community × Preconceived ideas	✓ Need to bring the community on the journey	+ Agreed mandate for engagement across the system	– Perceptions hospital care is best – How do we educate across the continuum? No KPIs for this
	Requires greater priority		× Not a priority	✓ Need a vision to keep people well, not focus on illness	+ Policy directive + Requires designated resources	– Lack of focus on this at Board and Executive level