{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:44:34Z","timestamp":1792579474867,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.26970.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000}}],"reference-count":14,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["226688\/Z\/22\/Z"],"award-info":[{"award-number":["226688\/Z\/22\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Objective To systematically document the operational components, barriers, facilitators, and solutions of a quality improvement collaborative for antibiotic stewardship in intensive care units (ICUs) in the public sector of Argentina, using the Pathfinder methodological framework. Methods Retrospective, descriptive observational study using mixed methods. Data sources included a documentary review of protocols, standard operating procedures, monitoring reports, and host study publications; an online survey with closed and open-ended questions administered to research team members; and triangulation with findings from the host study\u2019s previously published process evaluation, structured according to Normalisation Process Theory. Integration was performed using the Pathfinder Tracker. Analysis combined descriptive statistics with content analysis of open-ended responses. Results Eleven stages of the research process were mapped, from question formulation to dissemination, with an estimated total effort of approximately 1,020 person-hours. The stages with the highest perceived difficulty (4\/5) were ethical and institutional approvals, data collection, analysis, and dissemination, which together accounted for approximately 50% of the total estimated effort. Barriers were identified across three domains: institutional and regulatory (heterogeneity of ethical requirements, absence of stable local coordinators, publication costs); operational and technical (complex data collection forms, displacement of implementation focus due to the burden of data collection, variable connectivity); and human resources and capacity (clinical workload, staff turnover, insufficient training in implementation science). Solutions included a collaborative format with mentoring, agile communication via accessible digital tools (REDCap, WhatsApp, Zoom), and the use of theoretical frameworks for structuring (NPT, CFIR). Conclusions The Pathfinder framework enabled a systematic and transferable reconstruction of the host study\u2019s processes, revealing barriers and solutions that conventional results reports do not capture. The findings are relevant for research teams in middle-income countries designing quality improvement collaboratives in complex hospital settings.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.26970.2","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:29:07Z","timestamp":1790054947000},"page":"522","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Process mapping of a collaborative quality improvement study to optimise the use of antibiotics in intensive care units in Argentina: a Pathfinder study"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-5061","authenticated-orcid":false,"given":"Javier","family":"Roberti","sequence":"first","affiliation":[{"name":"CIESP Buenos Aires Autonomous City of Buenos Aires National Scientific and Technical Research Council (CONICET)"},{"name":"Patient Safety and System Quality Buenos Aires Autonomous City of Buenos Aires Institute for Clinical Effectiveness and Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Patient Safety and System Quality Buenos Aires Autonomous City of Buenos Aires Institute for Clinical Effectiveness and Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Patient Safety and System Quality Buenos Aires Autonomous City of Buenos Aires Institute for Clinical Effectiveness and Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Facundo","family":"Jorro-Bar\u00f3n","sequence":"additional","affiliation":[{"name":"Patient Safety and System Quality Buenos Aires Autonomous City of Buenos Aires Institute for Clinical Effectiveness and Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel","family":"Garcia-Elorrio","sequence":"additional","affiliation":[{"name":"Patient Safety and System Quality Buenos Aires Autonomous City of Buenos Aires Institute for Clinical Effectiveness and Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"883-884","DOI":"10.1016\/j.cmi.2025.03.010","article-title":"Publishing infectious disease research from low- and middle-income countries.","volume":"31","author":"E Yusuf","year":"2025","journal-title":"Clin. 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EXTENDED DATA.","year":"2026","journal-title":"Zenodo."}],"updated-by":[{"DOI":"10.12688\/wellcomeopenres.26970.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000}}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:24:10Z","timestamp":1792578250000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":14,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.26970.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.26970.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.30616.r170266","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.30616.r169733","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.30616.r170266","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.30616.r169733","asserted-by":"object"}],"is-version-of":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.26970.3","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.30616.r169733, Sarunyou Chusri, Prince of Songkla University, Songkla, 24 Sep 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2#referee-response-169733","order":0,"name":"referee-response-169733","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.30616.r170266, Bode Ireti Shobayo, Karolinska Institutet, Stockholm, 09 Oct 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2#referee-response-170266","order":1,"name":"referee-response-170266","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Javier Roberti<\/b>; \n<i>Posted: 14 Oct 2026<\/i>; We thank the reviewer for a careful reading and for the constructive suggestions. We have revised the manuscript (version 3) as follows.  \n<b><i>Comment 1: It would not affect the scientific validity to reduce the repetition of terms such as \u201ctransferable knowledge\u201d, \u201ctransferable solutions\u201d and \u201ctransferable resource\u201d to improve readability. The discussion is a little repetitive regarding staffing shortages and barriers to implementation and could be more concise.<\/i><\/b>  \n<b>Response:<\/b> We thank the reviewer for this suggestion. We have reduced the use of \u201ctransferable\u201d throughout the manuscript and retained it only where it defines the study objective (Introduction). We have also shortened the Discussion. The paragraph on staffing shortages and research-capacity deficits has been condensed so that it no longer repeats barriers already reported in the Results. We have removed a sentence on equity, institutional memory and sustainability that appeared twice, once at the end of the recommendations and again in the closing paragraph. We have also removed from the closing paragraph a sentence restating the barriers.  \n<b><i>Comment 2: Although the survey instrument is available as supplementary data, the manuscript itself provides limited information concerning total number of survey questions, distribution of closed versus open-ended questions, and how pilot-testing influenced the final instrument.&nbsp;Future researchers attempting to replicate the study may find these details useful.<\/i><\/b>  \n<b>Response: <\/b>We thank the reviewer for this suggestion and have added a full description of the instrument to the Methods. The questionnaire comprised six items. The first was a closed, multiple-choice item recording the stages of the host study in which the respondent had participated. The other five were open-ended items asking respondents to describe, for each stage, their participation, the difficulties encountered, how these were resolved, the resources used and the lessons learnt most useful to other teams. Respondents were asked to write a separate paragraph for each stage. The predominantly open format was deliberate. The Pathfinder was originally intended to conduct in-depth interviews with all team members. When this proved unfeasible, the questionnaire was designed to reproduce the prompts of an interview guide in self-completed form. Alongside the questionnaire, respondents rated the difficulty of each stage in which they had participated on a five-point Likert scale. We also clarify that stage-level person-hour estimates were obtained in interviews with team researchers and the project supervisor.  \n<b>Comment 3: The manuscript states that findings from three data sources were triangulated, but the actual integration process remains somewhat unclear. Specifically, how were discrepancies between sources resolved?&nbsp;What criteria were used to determine convergence?&nbsp;Were contradictory findings encountered?<\/b>  \n<b>Response: <\/b>We agree that the integration process needed to be made explicit and have rewritten the corresponding section of the Methods. The three sources were entered stage by stage into the Pathfinder Tracker and each finding was classified as convergent, complementary or dissonant: \n<b>Convergent:<\/b> the same barrier, facilitator or solution was reported in at least two sources. \n<b>Complementary:<\/b> a finding was reported in one source only, was not contradicted by another, and added detail. \n<b>Dissonant:<\/b> sources gave incompatible accounts. Documentary records were treated as the reference. The survey and the process evaluation were treated as the sources for experiential accounts. Discrepancies were to be resolved by returning to the documentary record and, where they could not be resolved, both accounts would be reported. No direct contradictions were identified. The principal difference between sources was one of emphasis: the internal survey foregrounded regulatory and administrative barriers, whereas the front-line interviews of the process evaluation foregrounded clinical workload. We treated this as complementarity, consistent with the limitation already reported on respondent composition. These results are now reported at the beginning of the Barriers section","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-522\/v2#referee-comment-6771","order":2,"name":"referee-comment-6771","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was developed under Wellcome Trust Grant 226688\/F\/22\/Z, The Global Health Network Latin America and the Caribbean Project: Creating equity in health research by connecting excellence and sharing knowledge. The funder had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}