Table S1.

Site-Ordered Matrix of Magnitude and Valence of Outer Setting Constructs by Level of Implementation

Construct High Level of Implementation Medium Level of Low Level of Implementation Distinguishing
Implementation
Outer Setting
Patient Needs &
Resources
Magnitude Most Many All All Most All All Many Most No
Valence +/- +/- + +/- +/- 0 + 0 +/-
Cosmopolitanism
Magnitude Some Many Most All All Most All Many Some No
Valence + + +/- +/- + + + + +
External Policies
& Incentives
Magnitude Few Few Some Many Few Many Some Some Some No
Valence - 0 + - 0 0 + + 0
Other
Characteristics
Magnitude Few None Some Some Most None Some Some Few No
Valence 0 ~ +/- - +/- ~ + 0 +
Note: Peer pressure was not discussed in the interviews and therefore not included in this table.
Table S2. Site-Ordered Matrix of Magnitude and Valence of Intervention Inner Setting Constructs by Level of Implementation

Construct High Level of Implementation Medium Level of Low Level of Implementation Distinguishing
Implementation
A B C D E F G H I
Structural
Characteristics
Magnitude Many Most Many All Many Most Most All Some No
Valence +/- +/- - +/- +/- 0 + 0 +
Networks &
Collaborations
Magnitude Most Most Many All Most Most All Many Most No
Valence + +/- +/- + + + + + +
Communication
Magnitude Many Some Some Some Many Some Many Many Few No
Valence +/- +/- + +/- + + + + +
Culture
Magnitude Few None Few Few Many Some Few Many Few No
Valence +/- ~ + + + + + + +
Tension for
Change
Magnitude Few Many Some Few Few Some Few None Few Yes
Valence + + + 0 0 + + ~ +
Compatibility
Magnitude Most Many Many Some Most Most Most Many Some No
Valence + + + +/- + + + + +
Relative Priority
Magnitude Many Some None Some Few Some Some None Many No
Valence +/- + ~ + + 0 + ~ +
Organizational
Incentives &
Rewards
Magnitude Some None None None Few Few None None None No
 Valence + ~ ~ ~ + + ~ ~ ~
Goals and
Feedback
Magnitude Few Some Some None Few Many Few Some None No
Valence + + 0 ~ + + 0 0 ~
Learning Climate
Magnitude Few Some None None Some Some Some None None No
Valence + + ~ ~ + + + ~ ~
Leadership
Engagement
Magnitude Most Many Many Some Many Some Some Many Some Yes
Valence + + + + + +/- 0 + +
Available
Resources
Magnitude Most Some Many Many Most All Some All Many No
Valence + + +/- +/- + +/- + +/- +
Access to
Knowledge and
Information
Magnitude Some Many Many Few Some Few Few None Few Yes
Valence +/- + + +/- + 0 0 ~ -
Table S3. Site-Ordered Matrix of Magnitude and Valence of Individual Characteristics Constructs by Level of Implementation

Construct High Level of Implementation Medium Level of Low Level of Implementation Distinguishing
Implementation
A B C D E F G H I
Knowledge &
Beliefs
Magnitude Some Few All Some Most Some Many Many Some No
Valence 0 0 0 0 + + 0 0 +
Self-Efficacy
Magnitude None Some Some None Few None None Some Some No
Valence ~ + + ~ + ~ ~ + +
Stage of Change
Magnitude Few None None None Few None None Some None No
Valence 0 ~ ~ ~ + ~ ~ 0 ~
Identification
with
Organization
Magnitude Few None None None None None None None None No
Valence 0 ~ ~ ~ ~ ~ ~ ~ ~
Personal
Attributes
Magnitude Some Many All Many All Some Most Some Many No
Valence + + + + + 0 + + +/-
Table S4. Site-Ordered Matrix of Magnitude and Valence of Intervention Process Constructs by Level of Implementation

Construct High Level of Implementation Medium Level of Low Level of Implementation Distinguishing
Implementation
A B C D E F G H I
Planning
Magnitude Many Many Many Most Most Many Some Many Some No
Valence + + 0 +/- + + + + +
Engaging
Magnitude Few Some None None None None Few None None No
Valence + + ~ ~ ~ ~ 0 ~ ~
Formally
appointed
internal
implementation
leaders
Magnitude Many Many Many Few Many Most Some Some Few Yes
Valence 0 + +/- + + + 0 + 0
Champion/
Opinion Leaders
Magnitude Few Few Few None None Some Few None Few No
Valence + + + ~ ~ + + ~ +
External Change
Agents-ACS
Magnitude Few Some Most Some All Some Most Many Many No
Valence +/- + + +/- + 0 + + +
External Change
Agents-non-ACS
Magnitude None None Some None Few Some Few None Some No
Valence ~ ~ +/- ~ +/- + + ~ +
Executing
Magnitude Most Many Many Most Most Most Most All Many No
Valence 0 +/- +/- +/- +/- + +/- 0 -
Reflecting &
Evaluating
Magnitude Many Many All All Many Most Most All Many No
Valence +/- + +/- +/- +/- +/- + 0 0