Assessing the implementation of a new Enhanced Recovery Pathway in three hospitals

Abstract

Background: Enhanced Recovery Pathways (ERPs) are an increasingly popular approach to streamline surgical procedures. However, their effectiveness is limited by suboptimal implementation. In order to improve ERP implementation, it is important to understand the process of implementation and how this varies in different contexts. This qualitative study provides a rich description of the implementation of a new ERP in three UK hospitals. Methods: Individual, semi-structured interviews were conducted with three Service Improvement Leads (SILs) coordinating the implementation of an ERP at their hospitals. Each SIL was interviewed on three occasions over a 12-month period (totalling nine interviews). Interview topics included expectations of the process, problems encountered, perceived success of implementation, conceptualisation of role of SIL. Interviews were transcribed, and analysed thematically. Findings: A key theme developed was how SILs conceptualised barriers to implementation. This had two sub-themes: managing barriers to implementation, and acceptance of insoluble problems. Other themes included expectations of the implementation process, multi-disciplinary working, and peer support as a tool for problem solving. Discussion: Despite having different backgrounds, levels of experience, and working in different settings, there were areas of striking similarity between the SILs’ experiences. All three SILs reported a lack of resources as a barrier to implementing necessary changes for the ERP (e.g. providing requisite rehabilitation). Although the SILs held mixed opinions as to the success of ERP implementation at their hospitals, they all agreed that it highlighted the importance of clear documentation and guidelines. All SILs raised concerns about the long-term sustainability of the ERP.