Table 2

Additional quotes grouped by theme
The innovation: perceptions of miscarriage and MVA
“It is a very emotional sort of thing” “For residents and for trainees it’s the emotional content and sort of the technical content and trying to manage them both at once…In other procedures that we’ve introduced in recent years, the emotional content isn’t as high. I think it’s hard for people to balance that when you’re working so hard to learn a technical skill, then it’s hard to learn about caring for the patient at the same time, balancing those two things is really hard, but it’s what you have to learn.” (MD faculty and site champion)
“Knowing the distinction and how to tell the difference” “And then having in the miscarriage management [training] a whole lot of talk about the procedure being upsetting and all that I think it really emphasized the connection of miscarriage management to therapeutic abortion instead of normalizing the procedure.” (Faculty MD and site champion).
“Every time it's the first time.” “I think one of the big challenges is that it’s so rarely needed that every time you do you’re reinventing the wheel. And although we have a pretty good volume, we don’t have the volume that one would need to do enough procedures to make everybody feel comfortable.” (Faculty MD and site champion)
“Its pretty simple” “Being able to do this in our clinic is a cost saver for patients…our patients are more likely to follow through and I think patients appreciate the procedure …” (Faculty MD)
The RTI-MM dissemination strategy: champions, hands-on practice, and team training
“Ideas how other clinics rolled out the service” “I mean I had MVAs and stuff, but we hadn’t quite gotten to the point of having protocols and using them in the clinic” (Faculty MD and site champion)
The user systems: teamwork and scope of practice
“Hearing the same messages” “I’m kind of the…resource person for so much of what happens in the clinic. So although I might not ever be involved in one of the procedures (although I’d like to be just so I can be more tuned into what happens), I definitely need to know what’s going on.” (Support staff, Nurse supervisor)
Scope of practice…is a battle here “it’s a little bit political…we still end being a little more on the defensive and that’s part of the problem…as opposed to if I was a rural doc and I was the only one who offered this procedure, then everybody would be delighted I did it and nobody would give me a hard time about it, but in the urban setting, when there’s maybe a little bit different community standard and our OB backup isn’t doing miscarriage management in the clinic setting, then that feels a little bit trickier.” (Faculty MD)

Darney et al.

Darney et al. BMC Health Services Research 2013 13:123   doi:10.1186/1472-6963-13-123

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