Facilitators |
Physician autonomy | Beliefs about capabilities | “There is relative freedom in decision-making.” [R5] |
Culture of acceptance and collegial support | Environmental context and resources | “The [physician] group has pretty consistent practices, so if [an] approach is adopted, it tends to be followed.” [R40] “Culture that accepts restrictive transfusion strategy.” [R15] |
Multidisciplinary approach to education | Knowledge; behavioural regulation | “Multidisciplinary education surrounding guidelines for transfusion have diminished requests for transfusion when not indicated.” [R6] |
Use of clinical guidelines | Social/professional role and identity; behavioural regulation | “We have a local guideline supporting restrictive red blood cell transfusion practices.” [R26] |
Barriers |
Conflict between clinical specialties | Social influences | “No significant barriers among intensivists, but consulting services at times at odds.” [R29] |
Knowledge and skills of medical trainees | Knowledge; skills | “Our [intensive care unit] is staffed by residents at night, and they don’t always adhere to restrictive transfusion strategies.” [R12] |
Perceived nonissue | Optimism | “This [is] really NOT a problem, so why bother expanding on an answer to a question that did not need to be asked?” [R11] |