Background Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques.

Methods This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis.

Results Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process.

Conclusions The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.