Illustrative quotes related to necessity of flexibility for successful CDS tool implementation
| Subthemes | Participant quote |
| Need for flexibility in CDS tool implementation in order to adapt to diverse contexts | ‘I definitely agree that it [a CDS tool] needs to be flexible or customizable, 'cause one size is not gonna fit all. I think that rather than necessarily pre specifying specific outcomes or actions that should come from a scoring system it might be better to try and provide a risk or a probability of how likely it is that the child has sepsis or is gonna deteriorate and with that probability, decision-makers, hospital managers, service providers, can contextualize that probability to their own setting. If you're working in the rainy season and the hospital is extremely busy, then you're gonna have a different threshold for making your decision than if you're working in the dry season and there’s more capacity. I think trying to say that one decision is the correct one at all times of year or in different places is not likely to succeed.’ (Clinician, Asia) |
| Adaption to user level of training | ‘Something like this [a CDS tool for pediatric sepsis] would be desirable, there’s no doubt, particularly in a setting where a large—people with different levels of resources and training are looking after children. Certainly, that kind of a tool is what I understand should be the endpoint of what we are discussing or what the SCCM task force is trying to develop the criteria which are specific to children.’(Clinician, Asia) |
| Context-specific constraints | ‘Then, as I said, lack of other supporting systems, like internet, electricity, even, sometimes, water and soap—you produce guidelines that, when you are dealing with sepsis, this is how to prevent sepsis—the infection prevention and control—but the equipment to use or the supplies are not there. I think, briefly, those may be some of the barriers.’(Administrator, Africa) |
| Language translation and cultural tailoring | ‘Language [can be a big barrier] in this sense. Maybe a lot of software—if it’s developed in a platform, an app, or something–translates from English; and there are many Anglicisms that remain… So, it would have to be, or maybe they understand it that way, closer to central America, where there’s a different lexicon, a lot more mixed with Anglicisms than in South America. I think language is something we have to pay serious attention to, if we want to develop the tool. To make it as international as possible.’(Clinician, Latin America) |
| Leadership buy-in and support | ‘The other bit is that the management—the hospital, the facilities, the management plays a very key role in having these tools being used. The staff are more likely going to use the tools, if at all, the administration, if at all, their supervisors really appreciate and promote it or, yeah, love the tool and promote it among the staff.’(Clinician, Africa) |
CDS, clinical decision support.