Huang Reiping, Remer Sarah L, Knapp Leandra K, Cohen Mark E, Rosen Michael A, Hall Bruce L, Wick Elizabeth C, Ko Clifford Y
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Ann Surg. 2025 Apr 16. doi: 10.1097/SLA.0000000000006731.
This study explains successful implementation of hospital enhanced recovery programs (ERPs) through unique configurations of contextual and implementation conditions.
Despite proven benefits in improving surgical outcomes, ERPs are often ineffectively implemented in hospitals, possibly due to the complex ways in which the interventions, local environment contexts, and implementation processes intertwine.
Using coincidence analysis, a mathematical method for analyzing configurations, we identified sufficient and necessary conditions for ERP implementation success in a national surgical collaborative. Success (high improvement) was defined as being among the 25% of hospitals with the greatest improvement in ERP adherence rate over time. Explanatory conditions included implementation resources in five domains (knowledge of evidence supporting interventions, leadership support, team skills and cohesion, stakeholder buy-in, and appropriate workload and time), organizational readiness to change, and hospital characteristics (teaching status, bed size, surgical volume, and socioeconomic status (SES) of patient populations). Prevalence-adjusted (PA) consistency and contrapositive (PAC) coverage, measures of data fit, were used in model selection adjusting for outcome prevalence.
Of the 86 hospitals, 26 (30.2%) successfully implemented ERP. Three scenarios collectively explained success for >70% of the hospitals (PA consistency=0.719, PAC coverage=0.752): Low-SES hospitals ready to change despite lacking team skills and cohesion during implementation; hospitals with low surgical volume which were ready to change and had strong staff buy-in; and high-volume hospitals that lacked leadership support but had appropriate workload and sufficient time for implementation rollout.
Successful ERP implementation varied by local context and relied on organizational readiness to change, strong staff buy-in, appropriate workload and sufficient time.
本研究通过情境和实施条件的独特配置来解释医院强化康复计划（ERP）的成功实施情况。
尽管ERP在改善手术结果方面已被证明有益，但在医院中往往实施效果不佳，这可能是由于干预措施、当地环境背景和实施过程相互交织的复杂方式所致。
我们使用巧合分析（一种分析配置的数学方法），在一项全国性手术协作中确定了ERP实施成功的充分必要条件。成功（高度改善）被定义为在ERP依从率随时间改善幅度最大的25%的医院之中。解释性条件包括五个领域的实施资源（支持干预措施的证据知识、领导支持、团队技能与凝聚力、利益相关者的认可、适当的工作量和时间）、组织变革准备情况以及医院特征（教学状态、床位规模、手术量和患者群体的社会经济地位（SES））。在模型选择中使用患病率调整（PA）一致性和反证（PAC）覆盖率（数据拟合度的指标）来调整结果患病率。
在86家医院中，26家（30.2%）成功实施了ERP。三种情况共同解释了超过70%的医院的成功原因（PA一致性 = 0.719，PAC覆盖率 = 0.752）：低SES医院尽管在实施过程中缺乏团队技能和凝聚力，但准备好进行变革；手术量低且准备好进行变革并有员工大力支持的医院；以及缺乏领导支持但有适当工作量和足够时间进行实施推广的高手术量医院。
ERP的成功实施因当地情况而异，并且依赖于组织变革准备情况、员工的大力支持、适当的工作量和足够的时间。
