Abstract
BackgroundKnowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system.MethodsAlberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple’s, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12.ResultsForty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines.ConclusionsHealth care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.
Highlights
Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation
Qualitative research and evaluation studies have identified a variety of barriers and facilitators that influence ERAS care implementation, largely through interviews with ERAS nurse coordinators or champions [5,6,7]
Additional quotes that represent a range of viewpoints and the stages of ERAS development are included in Additional file 2 to illustrate the breadth of interviewee discussion
Summary
Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. Qualitative research and evaluation studies have identified a variety of barriers and facilitators that influence ERAS care implementation, largely through interviews with ERAS nurse coordinators or champions (i.e., healthcare providers heavily involved in ERAS) [5,6,7]. Spread of innovation has been defined as horizontal diffusion of best practices within an organization [8] It is influenced by local actions and context and relies on local (site or unit based) healthcare providers, managers and leaders. The Institute for Healthcare Improvement (IHI) has published a white paper that healthcare organizations can use to sustain improvements in the safety, efficiency and effectiveness of patient care [10] This framework highlights that the key to sustaining improvements, such are seen with ERAS implementation, is to focus on the daily work of frontline managers with support of a high-performing management system. Leadership at senior levels (board of directors, vice presidents, senior operating officers, chairs and chiefs of divisions) is necessary to cultivate and lead improvement throughout the organization, but smaller incremental steps within service delivery units can set the stage for whole system change
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