Table 2.

Benefits, facilitators and barriers to the CMS approach in general practice

	UK (Williams et al., 2009; Risi et al., 2015)	USA (Nemeth et al., 2008; Michael et al., 2013)	Australia (Dunham et al., 2018; Janamian et al., 2014)	The Netherlands (Gobel et al., 2012)
Benefits of CMS approach	Improved staff morale, empowerment, commitment and clarity of purpose Shift in culture towards a more active approach to individual and collective improvement Greater awareness of the practice’s function and individual roles to deliver it Improved communication within the team Reduced GP isolation and better emotional support Identifying and nurturing strengths, of both teams and individuals Greater capacity to manage externally imposed change
Facilitators	Inclusive leadership and Interdependence of the team Buy-in from all staff Maintaining a staff focus with investment in staff training and support Identification of champions of change Celebration of positive achievements The use of ‘real data’ to demonstrate improved outcomes External input to support change management Infrastructure to support teams/information technology
Barriers	Lack of staff buy-in, scepticism or dissent High staff turnover Communication difficulties within and across teams An inability to grasp the interdependencies of the system