Table 5.

Implementation strategies.

Implementation strategies	Themes	Quotations
Formal commitment	Motivated engagement	“I said we signed the contract to be on these calls. We have to do this, because we said we were going to. And if we’re not going to then we shouldn’t have done it.”
Funding	Motivated engagement	“I’m not going to lie, girls, we’re broke. That we were able to get it paid for, that sealed the deal.”
Training: in-person meetings	Highly valued for providing: An overview of the steps involved in the QI process An opportunity for peer networking Hands-on experience using QI processes and tools	They explained “why you have to go through all the steps, which in turn I could take to my team and say listen, guys, we have to do it this way because it makes more sense if we start it at the beginning instead of jumping to the end.”
		“I really like the interactive collaboration and bouncing ideas off- oh, this worked for them; let’s try it for us.” “Because people would think of things that I didn’t think of and it would make it so, okay, almost like an idea think box that I could pick from.”
		“By the time you actually got back to your health department, you had worked through this whole process and understood it, so that way you could start with your team and know what you were doing.”
Training: virtual meetings	Were difficult to prioritize over clinic needs	“When you have webinars in your health center, you get pulled away when there’s a crisis going on.”
Facilitation	Valued the personalized problem solving and support	“It was helpful to have an ACS member assigned to you because if I had questions, I could just send an email.”
Audit and feedback	Valued for: Generating friendly competition Holding them accountable	“Them knowing how they were performing and showing them how they were performing, and it was just a motivator to do it and to get everybody on board and everybody to work together.”
		“There are so many plates in the air all the time…so we couldn’t really lose momentum because we kept having to put in our data.”
Implementation team	Need to have the right people on the team	“It cannot just be QI people. There needs to be at least one clinical person on the team because those clinical people are the ones that have to document. They’re the ones that have to be in the face of the patient helping promote this.”
Using QI tools to identify barriers and facilitators	Valued the process maps as a way to identify barriers Did not value the Five Whys and Fishbone Diagrams	“We only had one referral specialist. We realized that she needed help, right there in that room during the boot camp…so we did bring on key staff throughout the year because of that current state and future state [process map].”
		“Maybe you don’t have to have the Five Whys and the Fishbone.”
		“The Five Whys was kind of an out there, like where does it go?”
Using QI tools to conduct cyclical, small tests of change	PDSA cycles allowed participants to see if a change worked and demonstrate progress	“If I implement a PDSA, I can see immediately if that worked.”