Table 2

Barriers to change identified through PDSA cycles classified with the Theoretical Domains Framework and the COM-B model17 20

BarrierTheoretical DomainDefinitionCOM-B
Lack of awarenessEnvironmental context and resourcesAny circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence and adaptive behaviourOpportunity
Physical
Finding and completing stickers perceived as unnecessary duplicationGoalsMental representations of outcomes or end states that an individual wants to achieveMotivation
Reflective
Bundle fatigue: 22 other bundles and checklists already in use on the AMUOptimismThe confidence that things will happen for the best or that desired goals will be attainedMotivation
Reflective
Conflict with sepsis and antibiotic policies and with guidance on renal ultrasound in AMUBeliefs about consequencesAcceptance of the truth, reality or validity about outcomes of a behaviour in a given situationMotivation
Reflective
Compliance with some bundle elements already perceived as goodBeliefs about capabilitiesAcceptance of the truth, reality or validity about an ability, talent or facility that a person can put to constructive useMotivation
Reflective
Not all bundle elements perceived as equally importantIntentionsA conscious decision to perform a behaviour or a resolve to act in a certain wayMotivation
Reflective
  • AMU, acute medical unit; COM-B, Capability, Opportunity, Motivation-Behaviour; PDSA, Plan-Do-Study-Act.