Table 4 Behaviours and change techniques identified, with examples of self-reported learning

Verbalising/sharing the mental model

Habit formation/self and peer monitoring/verbal persuasion/taking time out/feedback on behaviour

Peer-review of videos/identification of critical points/discussion of risk and the importance of speaking out loud and taking timeout for an overview

Thinking aloud sounds like a good technique (Doctor S);

Sometimes when you’re trying to get to the bottom of problem, somebody might say something and, you know, it triggers a thought process (Doctor I);

Talking out loud so it is obvious what I am doing, the plan, and what is needed (Nurse S);

I stepped away from the patient a little bit and said “right, what are we going to do next” (Doctor AV)

Good communication

Peer monitoring/social consequences/modeling/feedback on behaviour

Videos and presented materials/discussions of two-way communication/importance of documenting communication

To ensure communication in events is loud and clear between the team (Nurse S);

One of the learning points is just how difficult it is for telephone conversations to provide useful results to both sides (Doctor AV)

The communication skill for a rapid interaction has to be borderline pedantic (Doctor I);

Communications skills is really, really important, and someone has to listen and someone has to lead (Nurse I)

Managing and planning

Modeling/peer review/problem solving/coping planning/feedback on behaviour

Timelines of scenarios/identification of exemplars/elicitation of strategies employed in practice

The A&E and the stroke team can actually work as a team to actually achieve that door to thrombolysis time of 10 min… To change the practice I would probably get the A&E consultants and the A&E matron to actually be involved in this management of stroke so that the delivery of care can be given within the target time (Doctor I);

I’ve got this new mindset of going in, that I want to go in and it’s about being mentally prepared for any situation (Nurse I);

it’s quite difficult to (plan ahead) because you have your own patient to look after, and at the same time co-ordinate the ward (Nurse AV);

You need to know when to call for help, and when you are at the limit of what you can do on your own (Doctor AV)

Breaking down institutional barriers

Restructuring social environment/self-affirmation/reframing/identity/emotional consequences/pros and cons/social support/feedback on behaviour

Multiprofessional interactions/video review and discussion of leadership and followership/benefits and difficulties of speaking up to senior colleagues

Being a little more assertive, a little more proactive if not happy (Nurse S);

Human Factors- very interesting dynamic … nobody wants to be the first to say… because, what if you’re wrong? (Doctor AV)

Someone might not be more senior in the old fashioned hierarchical structure but at that moment in time is more ‘senior’ to you (Doctor AV)

Use of decision aids/tools

Prompts/cues/feedback on behaviour

Discussion/presentation of materials: checklists and clinical decision aids

Luckily … they’ve got protocols plastered up everywhere and when you do say… ‘get the protocol for that’ it appears (Nurse AV);

[I] made myself a little bit of space and went back to my ABC (Doctor AV)

Situational awareness

Restructuring physical environment/comparative imagining/conserving mental resources/feedback on behaviour

Video playback/discussion/focus on environmental cues and selective attention

Check where the anaphylaxis box is (Doctor S);

People can get focused on one thing […], focused on one issue and miss out other important things […] (Nurse I);