University of Alberta, 214 CSC Royal Alexandra Hospital, Edmonton, Alberta, Canada.
University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada.
BMC Health Serv Res. 2020 Apr 26;20(1):361. doi: 10.1186/s12913-020-05227-0.
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. 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.
Alberta 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.
Forty-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.
Health 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.
医疗保健从业者和管理人员实施增强型术后恢复（ERAS）护理的知识转化证据，使得医疗保健创新得以传播和扩大规模。需要从领导力的角度确定在卫生系统层面上，需要采取哪些措施才能随着时间的推移从实施过渡到可持续性。本研究的目的是系统地综合医疗保健领导者的反馈意见，为在整个卫生系统内进一步传播、扩大规模和维持 ERAS 护理提供信息。
艾伯塔省卫生服务局（AHS）是加拿大最大的卫生系统，每年在 50 多个手术地点进行约 280,000 例手术。在 2013 年至 2014 年期间，AHS 使用结构化方法在六个地点成功实施了 ERAS 结直肠指南。在 2016 年至 2018 年期间，六个地点中的三个将 ERAS 扩展到其他手术领域（妇科肿瘤学、肝切除术、胰切除术/Whipple 术和膀胱癌切除术）。本研究旨在探索和学习参与 AHS ERAS 实施扩展的医疗保健领导者的经验（例如，外科护理单元、医院或省级项目），并在此基础上进一步发展知识转移模型。在获得知情同意后，使用结构化访谈指南对领导者进行访谈。通过理论驱动的沉浸和结晶以及使用 NVivo 12 的模板编码，对数据进行记录、编码和定性分析。
对 44 名个人（13 名医生领导者、19 名主要临床医生和医院管理人员以及 11 名省级领导者）进行了访谈。确定了与支持环境相关的主题，包括资源、数据、领导力；拥护者和护士协调员的角色；以及通过变革管理、教育和团队进行能力建设。领导者的看法和角色在启动和实施、传播和可持续性方面发生了变化。障碍和促进因素与结果评估、实施的一致性、ERAS 护理的合规性以及多个指南的实施相关联。
医疗保健领导者在支持 ERAS 的传播、扩大规模和可持续性方面具有独特的观点和方法，与基于站点的 ERAS 团队不同。这些发现使我们了解领导者需要做什么或需要以不同的方式做什么来支持实施，并促进 ERAS 的传播、扩大规模和可持续性。
