A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery...

Area of Science:

• Colorectal surgery outcomes
• Healthcare quality improvement
• Implementation science

Background:

• Previous studies identified factors influencing enhanced recovery protocols (ERP) for colorectal cancer surgery.
• This study evaluates factors for successful implementation of a care pathway (CP) using mixed methods.

Purpose of the Study:

• To concurrently evaluate qualitative and quantitative factors associated with successful implementation of a colorectal cancer surgery care pathway (CP).

Main Methods:

• A comparative mixed-methods study involving 10 hospitals across 4 European countries.
• Pre- and post-implementation data collection, including patient outcomes and healthcare professional interviews.
• Analysis using extended Normalization Process Theory (eNPT) and joint display methodology.

Main Results:

• Protocol adherence increased from 56% to 62%, and length of stay (LOS) decreased by 2.1 days, with significant inter-hospital variability.
• Factors influencing success included CP integration, team experience and support, motivation, shared goals, management backing, and physician involvement.
• Top- and lowest-performing hospitals were analyzed to identify implementation differences.

Conclusions:

• While overall improvement was noted, significant variability in care pathway (CP) implementation exists among hospitals.
• Extended Normalization Process Theory (eNPT) helped conceptualize implementation factors.
• Multidisciplinary teams should prioritize shared goals, teamwork, daily integration, and management support for successful CP implementation.