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Complexity and involvement as implementation challenges: results from a process analysis.

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Summary

Implementation of the IMPROVE programme faced significant challenges, leading to varied and delayed execution across hospitals. Addressing complexity in study design and programme scope is key for future success.

Keywords:
Guideline adherenceImplementationMultifaceted approachPatient safetyPerioperative careStepped-wedge design

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Area of Science:

  • Healthcare implementation science
  • Quality improvement initiatives
  • Perioperative care optimization

Background:

  • The IMPROVE programme aimed to implement checklist-related improvements in perioperative care.
  • A stepped-wedge trial design was employed for the national perioperative guidelines.
  • Process analysis investigated implementation activities and challenges.

Purpose of the Study:

  • To analyze implementation challenges within the IMPROVE programme.
  • To understand variations in the execution of improvement initiatives.
  • To identify factors affecting professional involvement in the programme.

Main Methods:

  • Developed an involvement rating measure to quantify program execution.
  • Assessed the number and participation in IMPROVE implementation activities.
  • Compared quantitative data with qualitative field notes from nine hospitals.

Main Results:

  • Significant variation in hospital involvement ratings (0-6 on a 0-11 scale).
  • Key challenges included study design, hospital/personnel selection, programme scope, and external competitive events.
  • Factors like long duration, complex design, and inadequate team coverage hindered implementation.

Conclusions:

  • Process analysis explained limited and heterogeneous program execution.
  • High complexity in program, design, and setting contributed to challenges.
  • Recommendations include simplifying the program, adjusting study design, improving personnel selection, and enhancing management/surgeon commitment.