Table 3 Key Findings
Stages of ERAS Implementation/ Sustainability | |||
|---|---|---|---|
Initiate & Implement | Spread & Scale | Sustain | |
Themes | |||
Supportive Environment | What provides a supportive environment? | ||
Leadership | Strong, visible support at every level of leadership facilitates early stages | Leaders setting expectations that ERAS will continue and expand | Leaders’ pride in outcomes and confidence that ERAS practices will be standard AHS practice |
Resources | Funding for tools and practice changes | Plan for sufficient resources for expansion | Explicit resources sustainability plan |
Data | Essential for engagement of staff and physicians in practice change | Establish data standards; provide resources for data management | Establish core dataset; align with AHS data collection; assess skillset required for data management |
Nurse coordinators & Champions | How do these roles add value? | ||
Nurse coordinators | Build enthusiasm | Encourage compliance | Maintain practices |
Champions | Engage peers | Address misperceptions; migrate ERAS | Practice ERAS as usual standard of care |
Building Capacity | What builds ERAS capacity? | ||
Change Management | Include change management plan from outset | Encourage ERAS spread through peers | Changes need to be reinforced as standard practice |
Education | Essential for staff engaging in new practices | Support transfer of “lessons learned” across change areas | Ongoing need for continuous education (e.g., as staff changes) |
Teams | Regular ERAS team meetings within change area beneficial | Support relationship development across change areas | Collaboration at provincial level supports ERAS practice |
Enablers | What enables ERAS development? | ||
Multiple Guidelines | Some benefits when staff have positive ERAS experience | Ensure ERAS resources match scope of spread to multiple guidelines | Assess volume of change initiatives affecting staff |
Consistency | Consistency of ERAS processes supports early stages | Consistency across patients spread and scale | Consistent expectations and supporting resources to enable culture change |
Compliance | Leadership expectations for compliance support ERAS initiation and implementation | Support the use of ERAS data to encourage compliance | Establish minimum AHS standards (based on international standards) |
Outcomes | Communicate initial ERAS outcomes frequently to engage staff in change | Use outcome data to support areas where positive changes are slipping | Outcome data supports positive reinforcement of good outcomes for staff and patients |