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Table 2 The SAFE-LEAD Context tool adapted from CFIR

From: How to deal with context? A context-mapping tool for quality and safety in nursing homes and homecare (SAFE-LEAD Context)

Context domain Domain description Assessment/description Grade 1–5 (1 = low/small 5 = high/large)
1 2 3 4 5
Outer setting (Outside municipality—national level)
External policy and incentives National strategies to spread interventions       
National program for quality and safety       
Degree of national support for quality and safety work/competence       
Degree of available national quality indicators       
Degree of national digital quality and safety tools       
Regulatory framework Enforced self-regulation/control/accreditation/insurance       
Degree of regulatory pressure on managers       
Supervisory authority for quality of care       
Role of state in organizing of nursing homes and homecare Delegated to municipalities by law/state run/other       
Funding Degree of use co-payment of services       
Context domain Domain description Assessment/description Grade 1–5 (1 = low/small 5 = high/large)
1 2 3 4 5
Outer setting (Within municipality—local level)
Patient needs and resources The extent to which patient needs are known and prioritized       
Citizen involvement Degree of citizen involvement in the municipality       
Cosmopolitanism Degree organization is networked with other external organizations       
Degree of collaboration between municipalities in quality and safety       
Degree of local support and competence for quality and safety       
External policy and incentives External strategies to spread interventions       
Municipality size, location Number of inhabitants/city, rural       
Distance to hospital Hours to drive from nursing home/homecare       
Type of funding Private/public       
Digital infrastructure Degree of development of digital infrastructure including electronic error reporting systems       
Collaboration climate Degree collaboration between politicians and managers       
Financial status Degree of financial pressure to save costs       
Context domain Domain description Assessment/description Grade 1–5 (1 = low/smal 5 = high/large)
1 2 3 4 5
Inner setting (Within institution—organizational level)
Type of service Homecare/nursing home/level of treatment (describe)       
Structural characteristics Social architecture—degree of how many employees are clustered into smaller groups       
Nurse-patient ratio       
Number of managerial levels within institution       
Assessment of manager-employee ratio       
Institution size       
Degree of quality/safety infrastructure       
External demands Degree of consistency between external demands and clinical practice       
Patient and user involvement in quality and safety improvement Degree of possibilities for involvement of user/patient/next of kin involvement at system level (arenas, board, committees, survey, co-design)       
Degree of actual involvement of user/patient/next of kin at system level (arenas, board, committees, survey, co-design)       
Patient/user centeredness Degree of user/patient centeredness in service provision       
Work schedule Degree of organizing of work schedule according to patient needs       
Workforce Degree of age, maturity among staff       
Degree of part-time employment       
Degree of doctor availability       
Degree of nurses availability       
Degree of unskilled employees in the work force       
Degree of access to, and use of, inter-professional competence such as psychologist, occupational therapist and physical therapist       
Competence Degree of competence level among work force (registered nurses, resource groups, improvement team, professional development nurses)       
Degree of delegating responsibility in acquiring knowledge in specific subjects to staff       
Engagement The degree managers support and engage staff in quality and safety improvement work       
Networks and communications Nature and quality of social networks, formal and informal communication       
Degree of arenas and structure for inter-professional collaboration       
Degree of attention to handover as a risk area       
Culture Norms, values, and basic assumptions of organization       
Degree of interest in improvement work within the organization       
Implementation climate Capacity for change, shared receptivity to improvement interventions, extent to which use improvement is rewarded, supported, and expected within organization       
Readiness for implementation Tangible indicators of organizational commitment to quality and safety improvement intervention       
Availability of resources Degree of available time to work with improvement       
Degree of available funding for improvement work       
Autonomy Degree of autonomy in how to utilize available resources