Table 3 Refined CMOs: inhibiting contexts

Characteristics of data

CMO 32

When data are not captured and presented in an interoperable way with consistent definitions (C) commissioners will have difficulty using them (O) because they have difficulty drawing conclusions (M) and doubt the data’s credibility (M) and have difficulty following the patient’s journey (M)

When data are not captured and presented in an interoperable way with consistent definitions (C) commissioners will have difficulty using them (O) because they have difficulty drawing conclusions (M) and doubt the data’s credibility (M)

CMO 33

In a context where commissioners suspect that commissioning data are inaccurate or contradictory (C) they will not use them in commissioning decisions (O) and may seek alternative sources of evidence, including qualitative information (O) because they do not trust them (M) and have difficulty drawing conclusions (M) and they fear they may be challenged and lose credibility (M)

In a context where commissioners suspect that commissioning data are inaccurate or contradictory (C) they will not use them in commissioning decisions (O) because they do not trust them (M) and have difficulty drawing conclusions (M)

CMO 34

In a context where (clinical) commissioners find that the data available contradict or are in tension with their experience and knowledge (C) commissioners may become skeptical of the data (O) because they are mistrustful (M)

In a context where (clinical) commissioners believe there is misalignment between data and their own clinical experience or information received from other clinicians (C) commissioners may become skeptical of the data (O) because they are mistrustful (M)

Commissioners’ capabilities, roles, perceptions, and intentions

CMO 35

In a context where commissioners are subjected to financial pressures (C) they may choose to make commissioning decisions based on little or no evidence (including data) including at the expense of using data related to potential (clinical) improvements (O) because they feel obliged to prioritise financial issues (M)

Silence (CMO not present)