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Table 5 Empirical support for within-site and between-site implementation themes

From: Between and within-site variation in qualitative implementation research

Site Within-site theme Support for within-site theme Support for between-site theme
Alpha Coordination processes between services rather than structural factors required for implementation · Co-located structure present, but limited cross-service collaboration · Space and preexisting consultation-liaison agreements are structural barriers
· POD and PC/MHI viewed as separate mechanisms for mental health access · Neither barrier resolved by collaboration; space resolved through PCMH innovation
· Local tailoring of processes addressed structural space barrier
Bravo Communication and collaboration facilitated PC/MHI implementation · Inter-service collaboration resolved differences · Mutual awareness of concerns between services
· Open communication facilitates patient access and process improvement · Similar barriers to Site Alpha, but in Site Bravo, barriers were resolved through negotiation
Yankee Poor collaboration between primary care and mental health caused implementation problems · Space conflict · Space and ER coverage agreements are structural barriers
· ER referral procedure conflict · Lack of collaboration appears to lead to conflicts over structural differences
· Different definitions of intervention success
Zulu Prior failure implementing co-located care influenced decision to physically separate services · MH leader report of prior failure · Prior space limitation influenced implementation
· No divergent perspectives of shared phenomena, possibly due to physical separation between PC and MH · PC/MHI adapted to preexisting space barrier
  1. Note: Between-site implementation theme: pre-existing structure influenced how PC/MHI was implemented; collaboration and cooperation among leaders and providers helped overcome these structural implementation barriers. POD = Psychiatrist on duty; PC/MHI = Primary Care/Mental Health Integration; ER = emergency room; PC = primary care; MH = mental health.