title: Contextual factors influencing the implementation of the obstetrics hemorrhage initiative in Florida.
abstract: The purpose of this study was to explore the multilevel contextual factors that influenced the implementation of the Obstetric Hemorrhage Initiative (OHI) among hospitals in Florida.
  
  
  
  A qualitative evaluation was conducted via in-depth interviews with multidisciplinary hospital staff (n=50) across 12 hospitals. Interviews were guided by the Consolidated Framework for Implementation Research and analyzed in Atlas.ti using rigorous qualitative analysis procedures.
  
  
  
  Factors influencing OHI implementation were present across process (leadership engagement; engaging people; planning; reflecting), inner setting (for example, knowledge/beliefs; resources; communication; culture) and outer setting (for example, cosmopolitanism) levels. Moreover, factors interacted across levels and were not mutually exclusive. Leadership and staff buy-in emerged as important components influencing OHI implementation across disciplines.
  
  
  
  Key contextual factors found to influence OHI implementation experiences can be useful in informing future quality improvement interventions given the institutional and provider-level behavioral changes needed to account for evolving the best practices in perinatology.
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Vamos
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Thompson
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cantor
authors.affiliation: The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL, USA.|Florida Perinatal Quality Collaborative, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Detman
authors.affiliation: Florida Perinatal Quality Collaborative, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bronson
authors.affiliation: Florida Perinatal Quality Collaborative, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Phelps
authors.affiliation: Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Louis
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Gregg
authors.affiliation: University of South Florida Health, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Curran
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: W
authors.initials: W
authors.lastname: Sappenfield
mesh_terms: D005260:Female; D005431:Florida; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010500:Perinatology; D010564:Personnel, Hospital; D006473:Postpartum Hemorrhage / Q000517:prevention & control* / Q000628:therapy*; D011247:Pregnancy; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*