Table 4.

Summary of support and resources provided for each of the five improvement steps

Improvement Step	Facilitated workshop	Materials and resources provided to PIs	Additional facilitation strategies
1. Form an improvement team	‘Set-up’ session	Instructions and worksheets Power Point slides to introduce PUMA to others	Implementation support phone calls between site PIs and PUMA study researcher (offered fortnightly)
2. Assess the system	‘Set-up’ session	Instructions and worksheets PUMA Standard and PUMA wheel PUMA system assessment tools (SSAT and FFT)	Implementation support phone calls between site PIs and PUMA study researcher (offered fortnightly)
3. Select and plan improvement initiatives	‘Action planning’ session	Instructions and worksheets	Implementation support phone calls between site PIs and PUMA study researcher (offered fortnightly)
4. Implement and review initiatives	‘Action planning’ session	Instructions and worksheets	Implementation support phone calls between site PIs and PUMA study researcher (offered fortnightly) Implementation support meetings (phone and face to face) between site PIs and PUMA study team
5. Sustain Progress		Instructions