Abstract
AIM/OBJECTIVE: To explore how nurses in university-affiliated polyclinics interpret incident-analysis findings and translate them into feasible, sustainable practice changes. BACKGROUND: Incident reporting and analysis are widespread, yet the “audit-to-action” gap persists. Little is known about how frontline nurses in ambulatory services convert recommendations into reliable routines amid workload and resource constraints. DESIGN: Qualitative process evaluation with a focused ethnographic orientation, reported according to COREQ. METHODS: Conducted across King Faisal University–affiliated polyclinics in Al-Ahsa, Saudi Arabia. Purposive sampling recruited registered nurses across roles. Data sources included semi-structured interviews, non-participant observation of safety huddles/quality meetings, and document review. Data were analyzed using reflexive thematic analysis, then mapped to implementation constructs to specify barrier→strategy pairings. RESULTS: Seventeen nurses participated. Four interrelated themes described the translation pathway: (1) From analysis to actionability—“taskifying” recommendations and using simple artefacts (checklists, prompts, brief scripts); (2) Feasibility in real time—uptake hinged on workflow fit, clear ownership, and minimal added paperwork under peak load; (3) Social infrastructure for change—leadership follow-through, psychologically safe huddles, and peer champions enabled adoption; and (4) Making change stick—balancing fidelity with local fit, maintaining regular feedback, and aligning resources/policies secured sustainment. CONCLUSIONS: Translating incident analyses into safer care requires small, engineered steps that protect feasibility and provide predictable feedback. Codifying core tasks, embedding prompts in existing workflows, and modest resourcing/policy alignment are practical levers for durable improvement in ambulatory nursing services. Findings provide practical guidance for nurse leaders on embedding safety recommendations into outpatient workflows through taskification, leadership follow-through, and psychologically safe huddles. PATIENT OR PUBLIC CONTRIBUTION: Two patient partners and one caregiver reviewed the interview guide and contributed to theme interpretation on communication, safety, and experience. TRIAL REGISTRATION: Not applicable (qualitative study). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-025-03974-1.