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Chapter 374Organisational context Impact of organisational context If a care organisation did not have a clear vision, or did not clearly articulate why an innovation should be implemented organisation-wide, teams tended to follow their own path. Broad support of the Board of directors for a course of action shared with care professionals and managers helped implementation. We do not have a clear vision of what we are going to do with it. Plus, there is still a lack of broad support. It is started very enthusiastically somewhere, but it does not yet touch the entire organisation. In that case, it will not be properly secured. (Support staff worker, meeting 1W)Organisational issues could also undermine implementation at the scale of individual teams. Care teams differ in their developmental phases, as some teams have more experienced support staff than others. Then it is rolled out as if every team is at the same level in terms of development. No thought is given to that. I would like it to be customised. That maybe there is an organisation-wide plan, that is needed, but that you do start looking at how can we then translate that on a tailor-made basis. (Policymaker, meeting 1S) Top-down implementationIn the case of top-down implementation the decision to implement an innovation was taken by the Board or management of the organisation. They set a framework to improve quality of care which gave clarity to managers and care professionals about organisational goals. However, participants mentioned that the Board did not always know what is feasible in implementing innovations. It is a large organisation and new methods and innovations often come from above. I%u2019m on the work floor, as a care provider there%u2019s not much you can do or say about that, you know. You get something imposed on you every time and then things come