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Table 1 Progressively identified and targeted barriers related to the OR context, and their linkages to theory-based strategies, proposed mechanisms of action, and the intervention activities

From: Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study

Targeted barriers Theory-based KT strategy Proposed mechanisms of action KT activities
Lack of teamwork, trust, and communication Interprofessional learning [66] and dialogue within a safe learning “container” [45] Increased levels of interaction Strengthened relations Improved understandings between professionals groups and managers Facilitating regular dialogue meetings between a selected group of professionals and managers (the Learning Lab group)
Lack of knowledge regarding HAI, patient outcome and HH performance Audit and feedback [60] Education based on adult learning theory [67], situated and experiential learning [68, 69] Increased motivation and commitment Internal drive for seeking knowledge and change Visualization of patient outcome data and behavioral feedback Mindful observations of one’s own and one’s peers’ HH practice Facilitated problem-based learning Co-creation of printed information material Reviewing “My five moments for hand hygiene”
Skepticism about the value of HH and AT “Celebrating” resistance Challenging basic assumptions [46] Decreased skepticism about the evidence in support of HH and AT Increased commitment to change Workshop welcome and encouraging participants’ diverse perspectives Facilitators actively seek to understand and address hesitation, questions and resistance in a respectful way Reviewing the evidence for HH and AT in relation to invasive procedures Co-producing printed evidence-based information on HH
Lack of tailoring of the clinical guidelines to the OR context Co-creation [70, 71] and design thinking [72] Relevant and meaningful HH and AT routines Step 1: Welcome and promote innovative new ideas; sense, probe, respond and reflect in an iterative process in the Learning Lab group Step 2: Involve OR staff in the testing, reflection and refining of standardized operational procedures
Lack of role models and opinion leaders Using facilitators [27] with social impact [28] Role modeling from credible and trusted sources Strive to create honest relationships between facilitators and participants Lab participant as change agents
Deficits in clinical leadership and change management skills Facilitating development of clinical leadership skills [46] Increased ability to understand and manage implementation in complex environments Increased awareness of the importance of leadership in change processes Interactive mini-lectures on leadership, implementation and change management