Table 5.

Explanations for changes in the Vision sub-scale.

	Where Vision score increased (7 sites)	Where Vision score decreased (6 sites)
Thematic statements	Competent management/leadership, and key people with clear roles helped to push the initiative forward Strong collaboration to co-design the initiative and good continuity of team members over time Feedback to reinforce a shared vision and build confidence in the achievability of outcomes Careful planning to ensure feasibility, regular meetings, and additional measures to ensure good information sharing Maintenance of focus by declining participation in other projects Sense of urgency, political support, and support of management that enhanced motivation/enthusiasm	Weak or unstable leadership External constraints affecting the initiative Absence of clearly delineated roles and responsibilities for team members Lack of a strong communication plan, and failure to develop a common understanding of the initiative Focus of the initiative lost over time, or had to change to fit external constraints (leading to frustration).