In this regard, there is no consensus on the most basic issues of CKD management, which negatively impacts on implementation.
However, comments made by participants identified a number of key issues and concerns that may impact on implementation of the recommendations.
This, in turn, was perceived to impact on implementation timelines, as users found it difficult to get used to new software that radically changed the way they were used to working.
In particular, we explored the reasons for the varying opinions around the choice of a screening test, and the broader contextual background to interviewees' opinions, as a way of identifying external factors that might be anticipated to impact on implementation.
Whilst the majority of interviewees did not express concerns about symptoms either being masked or exaggerated, this concern may impact on implementation of a screening programme and therefore was included in the list of master themes.
40 43 More recently, major organisational change in the NHS in 2013, when PCTs became Clinical Commissioning Groups and responsibility for the programme was transferred to local authorities at a time of reduced budgets, have also been reported to have impacted on implementation.
The lack of well-defined organizational structure for the CEC Mobiliser Programme from community level to the central MoEs or Regional Education Umbrellas level contributed to a certain degree of ambiguity vis-à-vis roles and responsiblities across all levels and negatively impacted on implementation, supervisory and monitoring activities.
The constant need of general practice to adjust to external changes emerged as a contextual factor impacting on guideline implementation.
The paper shows how discoveries made during the project impacted on the implementation of the tutorials while discussing some of the perceived benefits of this approach.
The results indicate that the supplier impacts on postponement implementation for the buying firm are not identical for all types of postponements and supplier flexibilities.
