Health Services Management Centre, University of Birmingham, Birmingham, UK.
The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
Age Ageing. 2023 Aug 1;52(8). doi: 10.1093/ageing/afad149.
The Perioperative care for Older People undergoing Surgery (POPS) service model is increasingly being implemented across care providers in the English and Welsh National Health Services.
The study aimed to produce evidence regarding clinical leaders' activities to implement POPS across different service contexts and to produce generalisable recommendations for future implementation.
A qualitative interview study was undertaken across six National Health Services hospitals with established POPS services. Interview participants were recruited on the basis of their direct involvement in the implementation and leadership of the service. Data collection involved semi-structured interviews with 26 people carried out between November 2022 and May 2023.
The implementation of POPS is often hampered by a lack of managerial and financial support, and apprehension amongst surgeons and anaesthetist about new ways of working. POPS leaders address these through five interconnected activities, each targeted at a combination of implementation factors. (i) Securing management and financial support. (ii) Professional engagement. (iii) Evidence building as a resource for demonstrating the clinical and operational benefits of POPS. (iv) Communication and engagement activities to promote and legitimise POPS to stakeholder groups. (v) Designated and distributed leadership to promote and coordinate implementation activities and to spread the service to new pathways.
Through a combination of activities POPS can be effectively implemented across different organisational contexts. Some aspects of these activities can be guided by shared resources and learning across sites, but others require adaption to local contextual barriers and drivers.
围手术期老年人护理（POPS）服务模式在英国和威尔士国民保健服务系统中的护理提供者中越来越多地得到实施。
本研究旨在提供关于临床领导者在不同服务环境中实施 POPS 的活动的证据，并为未来的实施提供可推广的建议。
在六家设有 POPS 服务的国民保健服务医院进行了一项定性访谈研究。根据他们直接参与服务的实施和领导的情况，招募了访谈参与者。数据收集包括 2022 年 11 月至 2023 年 5 月期间对 26 人进行的半结构化访谈。
POPS 的实施经常受到缺乏管理和财务支持以及外科医生和麻醉师对新工作方式的担忧的阻碍。POPS 领导者通过五项相互关联的活动来解决这些问题，每项活动都针对实施因素的组合。（i）确保管理和财务支持。（ii）专业参与。（iii）建立证据作为展示 POPS 的临床和运营效益的资源。（iv）沟通和参与活动，向利益相关者群体宣传和合法化 POPS。（v）指定和分配领导力，以促进和协调实施活动，并将服务扩展到新途径。
通过一系列活动，可以在不同的组织环境中有效地实施 POPS。这些活动的某些方面可以通过在站点之间共享资源和学习来指导，但其他方面则需要针对当地的障碍和驱动因素进行调整。
