Table 3 The logic model and developing theories of change

Workforce recruitment and retention, skills shortages, workforce participation rates (particularly in rural areas), inefficient use of staff, improved models of care, improved quality

Support from ‘powerful elites’, inter-disciplinary support, inter-institutional support, willingness to delegate, organizational culture that is supportive of change.

Team buy in, corporate sponsorship and senior management support, medical support, engagement of staff/clinicians

Working to full scope of practice, wider uptake of role, enhanced team processes/working, engagement of rural practitioners, improved relationships

Policy drivers

Clarity of role definition, supportive human resource (HR) policies, appropriate legislative scaffolding, funding secured, clear strategic direction, governance structures established

Resources to facilitate new roles

New resources to support the development and implementation of new roles, Codified processes, Training, Creation of new positions.

Service outcomes

Industrial agreements, Productivity Commission health workforce position paper, need to meet national targets

Sufficient funding, data quality and compatibility, dedicated resources and facilities, sufficient staffing, sufficient time, appropriate tools to support implementation, access to training and support, Calderdale Framework, evidence of success from other areas (literature/other sites) and resources.

Implementation of new roles and ability to work to full scope of practice, acceptance of new roles, better understanding of roles, improved service efficiencies increased service capacity, reduced waiting lists, cost savings,

Population drivers

Engagement

Population/patient outcomes

Demographics of the population, changing health needs, changing patient expectations, need to increase patient safety, need to increase accessibility.

Local engagement, patient engagement.

Improved patient satisfaction & functional outcomes, improved pathways of care, improved diagnostic accuracy, Improved accessibility.

Service drivers

Waiting lists, address service gaps, improved patient outcomes, improved efficiency of services, meeting demand/overcoming shortages

Remove strategic uncertainty

Project management

Sustainability and transfer of learning, other service redesign spin-offs, organizational learning, understanding the change process.

Minimize disruption from organizational changes, limit competing projects/priorities, limit implementation of new roles in times of substantial changes.

Clearly defined problem and scope, realistic project expectations, consistent expectations, skilled project management, project manager on site and connected to management and reporting structures.