BACKGROUND In the last 20 years governments have sought to introduce policy that improves the quality of care provided in hospitals, yet little research has been done to understand how these policies are implemented, factors that affect the implementation process or what should be considered by decision-makers during policy development or implementation planning. Experts with real-life experience in the introduction and implementation of policy are best placed to provide valuable insight into practical issues that affect implementation and the associated outcomes of these policies. METHODS A modified Delphi study of experts in hospital policy development and implementation was undertaken to investigate factors influencing the implementation of government-directed policy in the hospital setting. This study built on the findings of two previous studies - a qualitative study of clinician perspectives of policy implementation and a systematic review and meta-synthesis, in which common contextual factors and policy characteristics associated with policy implementation were ascertained. International experts with extensive experience in government-directed policy implementation at global, national, corporate, jurisdictional and organisational levels were asked to provide opinions on predetermined factors and the feasibility of considering these in policy development and implementation planning. Survey design and analysis was guided by the Consolidated Framework for Implementation Research. RESULTS Eleven experts from four countries and with different health system perspectives participated in the study. Consensus was reached on the importance of all predetermined factors in the first survey round with additional factors for investigation highlighted by participants for examination in subsequent rounds. On study completion, expert consensus was reached on 24 factors of importance; only 20 of these factors reached consensus for feasibility. CONCLUSIONS Study findings indicated that, whilst there are multiple factors of importance in policy implementation across all Consolidated Framework for Implementation Research domains, some factors, such as establishment of roles and responsibilities for implementation and organisational lines of accountability, are feasible for consideration at a hospital level only. In addition, four factors did not reach consensus in terms of feasibility, indicating that it may not be practical to consider all factors of importance when implementing policy; this has important implications for implementation planning and resource allocation.

中文翻译：

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医院环境中政府主导政策的实施：Delphi研究的改进。

背景技术在过去的20年中，政府一直试图引入可改善医院提供的护理质量的政策，但很少有研究了解这些政策的实施方式，影响实施过程的因素或决策中应考虑的因素。制定政策或实施计划时的决策者。在引入和实施政策方面具有实际经验的专家可以最好地提供有价值的见解，以了解影响实施和这些政策的相关结果的实际问题。方法对医院政策制定和实施方面的专家进行了改进的德尔菲研究，以研究影响医院环境中政府主导政策实施的因素。这项研究建立在前两项研究的发现基础上-对临床医生对政策实施的观点进行定性研究，以及系统地回顾和综合分析，其中确定了与政策实施相关的常见背景因素和政策特征。要求在全球，国家，公司，司法管辖区和组织各级具有政府指导性政策实施经验的国际专家就预定因素以及在政策制定和实施计划中考虑这些因素的可行性提供意见。问卷调查的设计和分析以实施研究综合框架为指导。结果来自四个国家，具有不同卫生系统观点的11名专家参加了该研究。在第一轮调查中就所有预定因素的重要性达成了共识，参与者强调了其他调查因素，以便在随后的回合中进行检查。完成研究后，就24个重要因素达成了专家共识；这些因素中只有20个在可行性上达成共识。结论研究结果表明，尽管在所有合并实施框架研究领域中，在政策实施中有多个重要因素，但某些因素，例如确立实施的角色和责任以及组织问责制，在医院中是可行的。仅级别。此外，在可行性方面，有四个因素未能达成共识，表明在实施政策时考虑所有重要因素可能并不切合实际；这对实施计划和资源分配具有重要意义。