Themes illustrating legitimacy
| Case A | Case B | |
| Subject position | Peripheral | Central |
| Structural legitimacy | ||
| Executive approval: imprimatur to undertake the work | ✓ | ✓ |
| Multidisciplinary improvement team embedded within hospital P: authority in relation to expertise and understanding of context | ✓ | ✓ |
| Credentialed improvement team: bolstered their authority using ‘diplomacy’, build trust and acceptance | ✓ | ✓ |
| Normative legitimacy | ||
| Implementation of established knowledge (evidence and standards: establishes a legitimacy of ‘need’ and ‘moral’ basis for changing practices) | ✓ | ✓ |
| Recognised theory-based implementation approaches: improves adoption and integration into routine practice | ✓ | ✓ |
| In-depth formative assessment about envisaged improvement with target clinicians: builds clinician engagement | ✓ | X Diminished capacity to sustain engagement due to team members’ redeployment |
| Patient involvement and engagement | ✓ | X Indirectly through representatives |
| Improvement outcomes | Achieved positive changes | Achieved time limited positive changes |