Table 2 The SAFE-LEAD Context tool adapted from CFIR

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

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

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