Applying system support mapping combined with the matrixed multiple case study approach to identify and analyse implementation determinants: lessons from a multi-site implementation study in German neonatal intensive care units
Interventional trial reveals structured determinant mapping in neonatal intensive care units, indicating how cross-site comparisons inform tailored strategies.
Key Points
To introduce and demonstrate a six-step methodology combining System Support Mapping and the Matrixed Multiple Case Study approach for identifying implementation determinants in multi-site healthcare settings.
Analyzed semi-structured interviews from key personnel across five German neonatal intensive care units participating in the Neo-MILK lactation support and donor milk bank trial (DRKS00025058).
Applied directed content analysis using deductive System Support Mapping elements and inductive contextual codes.
Synthesized findings via Matrixed Multiple Case Study analysis into individual maps (steps 1–3) and a comparative cross-site matrix (steps 4–6).
Within-site analysis revealed that specific resources act as facilitators, barriers, or both simultaneously based on role-specific needs and local context.
Cross-site matrix evaluation distinguished between homogeneous determinant patterns shared across hospitals and heterogeneous patterns unique to specific sites.
The integrated workflow provided an empirical structure to separate universally applicable implementation strategies from site-specific adaptations.