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Table 3 Key Findings

From: Moving enhanced recovery after surgery from implementation to sustainability across a health system: a qualitative assessment of leadership perspectives

 Stages of ERAS Implementation/ Sustainability
Initiate & ImplementSpread & ScaleSustain
Themes
Supportive EnvironmentWhat provides a supportive environment?
LeadershipStrong, visible support at every level of leadership facilitates early stagesLeaders setting expectations that ERAS will continue and expandLeaders’ pride in outcomes and confidence that ERAS practices will be standard AHS practice
ResourcesFunding for tools and practice changesPlan for sufficient resources for expansionExplicit resources sustainability plan
DataEssential for engagement of staff and physicians in practice changeEstablish data standards; provide resources for data managementEstablish core dataset; align with AHS data collection; assess skillset required for data management
Nurse coordinators & ChampionsHow do these roles add value?
Nurse coordinatorsBuild enthusiasmEncourage complianceMaintain practices
ChampionsEngage peersAddress misperceptions; migrate ERASPractice ERAS as usual standard of care
Building CapacityWhat builds ERAS capacity?
Change ManagementInclude change management plan from outsetEncourage ERAS spread through peersChanges need to be reinforced as standard practice
EducationEssential for staff engaging in new practicesSupport transfer of “lessons learned” across change areasOngoing need for continuous education (e.g., as staff changes)
TeamsRegular ERAS team meetings within change area beneficialSupport relationship development across change areasCollaboration at provincial level supports ERAS practice
EnablersWhat enables ERAS development?
Multiple GuidelinesSome benefits when staff have positive ERAS experienceEnsure ERAS resources match scope of spread to multiple guidelinesAssess volume of change initiatives affecting staff
ConsistencyConsistency of ERAS processes supports early stagesConsistency across patients spread and scaleConsistent expectations and supporting resources to enable culture change
ComplianceLeadership expectations for compliance support ERAS initiation and implementationSupport the use of ERAS data to encourage complianceEstablish minimum AHS standards (based on international standards)
OutcomesCommunicate initial ERAS outcomes frequently to engage staff in changeUse outcome data to support areas where positive changes are slippingOutcome data supports positive reinforcement of good outcomes for staff and patients