Table 1.

Framework of factors influencing clinical practice5

Factor typesInfluencing contributory factorsExamples
Institutional contextEconomic and regulatory context; national health service executive; clinical negligence scheme for trustsInconsistent policies, funding problems
Organisational and management factorsFinancial resources and constraints; organisational structure; policy standards and goals; safety culture and prioritiesLacking senior management procedure for risk reduction
Work environment factorsStaffing levels and skills mix; workload and shift patterns; design, availability, and maintenance of equipment; administrative and managerial supportHigh workload, inadequate staffing, or limited access to essential equipment
Team factorsVerbal communication; written communication; supervision and seeking help; team structure (consistency, leadership, etc)Poor communication between staff
Individual (staff) factorsKnowledge and skills; competence; physical and mental healthLack of knowledge or experience of specific staff
Task factorsTask design and clarity of structure; availability and use of protocols; availability and accuracy of test resultsNon-availability of test results or protocols
Patient factorsCondition (complexity and seriousness); language and communication; personality and social factorsDistressed patient or language problem