Beliefs about consequences
Often regarded as core to clinical reasoning, this domain covers the perceived benefits and harms of a clinical action. In some contexts it can also include consequences for the clinician such as workload, pay, career progression, or for the hospital or health service.
Includes the ‘how’ of changing clinical practice: what are the practical strategies that would facilitate or hinder uptake of a new practice.
Beliefs about capabilities
How confident clinicians are that they could change their practice effectively.
Includes issues such as work stress, patient anxiety and other emotional factors that may help or hinder the uptake of new approaches to care.
Includes the physical (including financial) issues that may limit change, including staffing levels and time as well as equipment or space.
Knowledge of the field (that is, whether there is adequate evidence) and individuals’ knowledge of the evidence or of a guideline.
Memory, attention and decision processes
The level of attention that is needed to perform the key clinical action (that is, whether forgetting is likely to be a problem) and the processes by which clinical decisions are made by individuals and teams.
Motivation and goals
The relative priority that is given to one clinical issue, compared with other demands.
Social/professional role and identity
The clinical thinking and norms of a particular profession.
Covers the possibility that new skills would be required by the staff that are required to implement a new procedure.
The influence of other individuals or groups on clinical practice; for example, patients, patients’ families, pressure groups.
Nature of the behaviours
Some new practices are very similar to current practice and so are easier to implement than new practices that require a dramatic change in ways of working.