Table 2.

Facilitators identified in the QICs mapped to the CFIR domains and constructs

CFIR domain	CFIR construct	Facilitators	Refs	Reliability of findings based on MMAT
Intervention characteristics	Adaptability	QIC participation highlighted possibilities for using the approach for other aspects of stroke care and other clinical conditions.	[31, 34]	Medium
	Complexity	Processes of care within a geographical area or where a specific team in responsible may be more susceptible to improvement using a QIC.	[21, 23]	Medium
Outer setting	Patient needs and resources	Greater patient feedback may change staff perceptions of improvement being more than just a ‘tick-box exercise’.	[27]	High
	Cosmopolitanism	Collaborative action facilitates the exchange of ideas, best practice, and experience.	[28, 33, 36, 39]	Low-high
		Collaborative action fosters relationships between groups, improving cooperation and an emphasis on achieving results.	[28, 29, 33, 39]	Low-high
	External policy and incentives	External factors such as national level efforts during the QIC can influence the level of success achieved by using this approach.	[23, 26, 29, 38]	Medium-high
Inner setting	Structural characteristics	Stroke teams that function well may be associated with well organised stroke services and successful QI.	[28, 37]	Low-medium
		Teams composed of professionals and management may be more effective at implementing successful improvements and making decisions.	[28, 37]	Low-medium
	Networks and communications	Communication of the QIC to the organisation fosters support, provides networking opportunities, and enables change.	[27–29, 33, 35]	Low-high
	Culture	Longer serving members of staff may be more positive towards innovation.	[27]	High
	Implementation climate: Compatibility	Resolutions for solving issues related to implementation include assigning responsibility to a named individual, establishing accountability, and devising new workable processes.	[34, 39]	Low-high
		Positive baseline performance for acute stroke care may be associated with positive QI outcomes.	[23]	Medium
	Implementation climate: Relative priority	Identifying shared agenda and goals can unite QIC teams and help to find solutions.	[39, 40]	High
	Implementation climate: Organisational incentives and rewards	Motivation for change can be encouraged by organisation recognising activities undertaken by stroke teams.	[39]	High
	Implementation climate: Goals and feedback	Clinical feedback to staff is helpful for fostering successful QI.	[23, 30, 31, 33, 35, 39]	Low-high
		Positive feedback mechanisms include annotated control charts, provider prompts (checklists), storyboards and knowledge translation strategies.	[23, 30, 31, 33, 35, 39]	Low-high
		Focusing on essential topics and specifying aims if both necessary and helpful for achieving improvement results within a limited timeframe.	[28, 39]	Low-high
	Implementation climate: Learning climate	Learning sessions motivate change through opportunities to share and learn best practices and become familiar with QI tools.	[33, 39]	Medium-high
		Access to teaching from experts facilitates improvement.	[35, 36]	Low-medium
		Improving the content and accessibility of learning sessions may increase QIC participation.	[28–30]	Low-high
	Readiness for implementation: Leadership engagement	Involving and engaging senior leaders in the QIC and communicating progress to them is associated with improvement.	[27–29, 31, 35, 39]	Low-high
	Readiness for implementation: Available resources	Realistic time and resources for services should be provided for improvements to be achieved.	[31, 35, 40]	Low-high
		Recording staff time spent and resources used on improvement activities can be used to assess cost-effectiveness.	[25]	Medium
	Readiness for implementation: Access to knowledge	Access to useful information empowers teams to develop greater knowledge of best practice, patient care and QI methods and enables the appropriate induction of new staff.	[25, 28, 31, 33, 35, 40]	Low-high
		Stroke services with less knowledge and experience of QI may be more amenable to the approaches employed in a QIC.	[37]	Medium
Individual characteristics	Knowledge and beliefs about the intervention	Engagement with staff helps to foster a positive attitude towards changes implemented from the collaborative.	[27, 31]	Medium-high
	Self-efficacy	When staff understand the value of a QIC for improving patient care, it is a motivator for change.	[31, 39]	Medium-high
	Individual identification with organisation	The opportunity to work with other organisations and see what they are doing is a motivator for change.	[39]	High
	Other personal attributes	Individual or team characteristics have an impact on levels of enthusiasm and motivation.	[28]	High
Process	Engaging: Champions	Engaging and stimulating teams throughout the QIC is essential in encouraging improvements for patient care.	[27–29, 31, 39]	Low-high
		Interacting with leaders in meetings provides opportunities to discuss care and facilitates clinical engagement in QI activities.	[35]	High
	Engaging: external change agents	External facilitators empower teams to take ownership of the changes and provide support to clinicians on how best to navigate changes across services.	[40]	High
	Executing	Best practice examples were adopted by participating hospitals and may mediate improvements.	[34, 36]	Medium
		Consistency in employing the QIC approach and team participation, considering sustainability of changes, may support continued improvement.	[28, 29, 35]	Low-high
		A structured project approach, focusing on measurable outcomes, stimulates action and efficiency in stroke care.	[25, 28]	Low-medium
	Reflecting and evaluating	Monthly monitoring data encourages teams to reflect on their current practice, celebrate success and identify areas for improvement.	[39]	High