Table 9 Initial program theory 4...

Table 9

Initial program theory 4

	Strategy	Context	Mechanism	Outcome
GM^I	Delegated alignment and measurement of performance targets along governance structure on the locality level	Focussing on localities' core targets and how to measure them while resources are scarce	Required the locality to put their joint effort behind wanting to make the population level changes to secure their credibility	Implemented a shared data repository
VHCS^II	Development of systems for learning, monitoring, measuring and information flows along governance structures	Lack of resources	Governance structures were felt to insufficiently ensure VHCS^II credibility due to insufficiencies in the required data and learning structures to monitor and communicate initiatives' outcomes	Insufficiencies hindered keeping staff members and partners on board
GEN-H^III	Organized a learning environment	Convener supported e.g.: involving a health information exchange organization planning and developing operating procedures in collaboration with stakeholders	Wanting to see results to secure their credibility, convener appreciated the time taken to build relationships as stakeholders felt like the convener understood and recognized the problems they were facing	Working with the technology team improved convener's credibility
GK^IIII	Organized a learning environment	Implemented a compatible EHR* across all providers and learning facilities using feedback cycles. Resistance to EHR due to perceived lack of funding	Convener felt pressure to show GK's success as they had staked their reputation upon it	It took longer than expected to implement the shared EHR system to establish continuous improvements and to establish ROI**

	Strategy	Context	Mechanism	Outcome
GM^I	Delegated alignment and measurement of performance targets along governance structure on the locality level	Focussing on localities' core targets and how to measure them while resources are scarce	Required the locality to put their joint effort behind wanting to make the population level changes to secure their credibility	Implemented a shared data repository
VHCS^II	Development of systems for learning, monitoring, measuring and information flows along governance structures	Lack of resources	Governance structures were felt to insufficiently ensure VHCS^II credibility due to insufficiencies in the required data and learning structures to monitor and communicate initiatives' outcomes	Insufficiencies hindered keeping staff members and partners on board
GEN-H^III	Organized a learning environment	Convener supported e.g.: involving a health information exchange organization planning and developing operating procedures in collaboration with stakeholders	Wanting to see results to secure their credibility, convener appreciated the time taken to build relationships as stakeholders felt like the convener understood and recognized the problems they were facing	Working with the technology team improved convener's credibility
GK^IIII	Organized a learning environment	Implemented a compatible EHR* across all providers and learning facilities using feedback cycles. Resistance to EHR due to perceived lack of funding	Convener felt pressure to show GK's success as they had staked their reputation upon it	It took longer than expected to implement the shared EHR system to establish continuous improvements and to establish ROI**

Note(s): Create a learning environment to secure initiative's credibility. ^IGM: Greater Manchester; ^IIVHCS: Vancouver Healthy City Strategy; ^IIIGEN-H: Generation Health; ^IIIIGK: Gesundes Kinzigtal; EHR*: Electronic Health Records system; ROI**: return on investment

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