138 Chapter 6 formal and informal leaders must demonstrate the courage and vision to challenge existing norms and guide healthcare providers through the transition.32 34 35 39 46-48 Analysis of the included articles and documents revealed 16 CMOCs, with 4 CMOCs captured under each of the following themes: - Macro-level challenges; - Leadership; - Role ambiguity and conflict; - Personal and professional boundaries. Only selected CMOCs that underpin each theme are presented. The description delineates the elements constituting the C, MRc, MRp, and their corresponding O. All 4 themes are discussed along with key literature references. The literature rarely provided a clear description of all 3 components, making retroductive reasoning critical to ensure complete CMO configurations. A full list of all 16 CMOCs can be found in online supplemental material 4. Figure 3: Framework on the multilevel contextual influences
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