Table 1 Progressively identified and targeted barriers related to the OR context, and their linkages to theory-based strategies, proposed mechanisms of action, and the intervention activities

Lack of teamwork, trust, and communication

Interprofessional learning [66] and dialogue within a safe learning “container” [45]

Increased levels of interaction

Strengthened relations

Improved understandings between professionals groups and managers

Facilitating regular dialogue meetings between a selected group of professionals and managers (the Learning Lab group)

Lack of knowledge regarding HAI, patient outcome and HH performance

Audit and feedback [60]

Education based on adult learning theory [67], situated and experiential learning [68, 69]

Increased motivation and commitment

Internal drive for seeking knowledge and change

Visualization of patient outcome data and behavioral feedback

Mindful observations of one’s own and one’s peers’ HH practice

Facilitated problem-based learning

Co-creation of printed information material

Reviewing “My five moments for hand hygiene”

Skepticism about the value of HH and AT

“Celebrating” resistance

Challenging basic assumptions [46]

Decreased skepticism about the evidence in support of HH and AT

Increased commitment to change

Workshop welcome and encouraging participants’ diverse perspectives

Facilitators actively seek to understand and address hesitation, questions and resistance in a respectful way

Reviewing the evidence for HH and AT in relation to invasive procedures

Co-producing printed evidence-based information on HH

Lack of tailoring of the clinical guidelines to the OR context

Co-creation [70, 71] and design thinking [72]

Relevant and meaningful HH and AT routines

Step 1: Welcome and promote innovative new ideas; sense, probe, respond and reflect in an iterative process in the Learning Lab group

Step 2: Involve OR staff in the testing, reflection and refining of standardized operational procedures

Lack of role models and opinion leaders

Using facilitators [27] with social impact [28]

Role modeling from credible and trusted sources

Strive to create honest relationships between facilitators and participants

Lab participant as change agents

Deficits in clinical leadership and change management skills

Facilitating development of clinical leadership skills [46]

Increased ability to understand and manage implementation in complex environments

Increased awareness of the importance of leadership in change processes

Interactive mini-lectures on leadership, implementation and change management