Table 7 Barriers and Enablers Theme; Quotes by Topic

Topic

Quote

Outcomes

So I think that showing people the data that good practice leads to good outcomes was a very powerful tool in- that’s probably the most convincing thing I could do…I guess it would be a short term laboring, that’s a management problem - where you do the change and you measure outcomes you get a short term view. So I think that was very good for that. I think that was the most powerful tool that I had. Again, the coordinator was very supportive of that.

Physician_8

Multiple Guidelines

[Implementing one pathway…] It seemed to be very doable. When we got to multiple pathways, it wasn’t that it wasn’t doable, but what I started to hear from the sites…was more of a little bit of a sense of exhaustion and frustration with multiple things coming at once. So I started to hear “Okay I can handle one pathway” and especially from the site sponsors right? Through the site administrators, they are kind of like “yeah I can tap my one physician on the shoulder” around this one pathway. But when there is multiple pathways I’ve started to get calls from them or hear from them more about general frustration with provincial teams, with the networks. And I think it’s not because they don’t know it was coming but because it felt, all the sudden it felt a little bit overwhelming. Because we were recruiting people at the same time and then we were rolling out and that requires a larger role for some of the administrators.

Provincial_04

Consistency

ERAS should become best practice for all patients. We need these standardized order sets for all patients - have to be out of bed day 0, all patients should have Ensure, etcetera. Then there would be a better uptake. But because we only have say 25–50% of patients are ERAS on units, I am speaking to post op, they’re the patients that are the most work. When really they are the patients that are getting the best care, if these measures are being done…. I don’t like to say ERAS anymore as I say enhanced recovery, because I feel like ERAS has gotten this negative definition to it where when you say enhanced recovery you can’t argue with that, right?

Clinician_16

Compliance

Some it is organic, because everyone is getting off ward with some of the basic elements of ERAS. Some of the fine tuning stuff that are harder, like the big changes I think have been done, but some of the fine tuning in improving your compliance, no really active process on that. It’s challenging and truthfully I don’t how all of that is being achieved right now without having the learning collaborative and some of the provincial dedicated support really hands on. I think that the teams are doing as well as they can but I am sure it’s a challenge with the capacity and the ability of the coordinators to really be as involved because what we see is, unfortunately, without really good dedicated coordinator time hands-on on the unit working with the nurses, working with the physicians, advocating for change constantly, it’s really hard.

Provincial_06