Defining barriers and enablers for clinical pathway implementation in complex clinical settings

Area of Science:

• Health Services Research
• Implementation Science
• Qualitative Research Methods

Background:

• Clinical pathways can improve patient outcomes and reduce costs, but their effectiveness is hindered by inconsistent implementation.
• Understanding factors influencing implementation in dynamic emergency department (ED) settings is crucial.

Purpose of the Study:

• To explore factors influencing the implementation of clinical pathways in community emergency departments.
• To identify barriers and enablers from the perspective of ED staff and administrative leads.

Main Methods:

• A descriptive, qualitative study involving 15 community hospitals in Ontario, Canada.
• Data collected via group discussions, site visits, and key informant interviews.
• Analysis guided by the Theoretical Domains Framework (TDF) and mapped to the COM-B model.

Main Results:

• Seven themes and 58 subthemes identified as barriers and enablers to clinical pathway implementation.
• Impacts observed at individual, team, and hospital levels.
• Frequently identified TDF domains included Memory, Attention and Decision Processes, Environmental Context and Resources, Behavioural Regulation, and Reinforcement.

Conclusions:

• A theory-based approach systematically identified implementation barriers and enablers.
• The COM-B model provided a framework for understanding the interaction of these factors in ED settings.