Mapping Implementation Strategies to Address Barriers to Commission on Cancer's Accreditation Standards in Breast...

The Commission on Cancer (CoC) introduced synoptic operative reports (SOR) as accreditation standards to increase adherence to cancer surgical standards. Due to large variations in implementation of past CoC accreditation standards, we used a theory-informed method to identify optimal implementation strategies for SOR integration.

Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews from December 2021-May 2022 focused on implementing the breast SOR with 31 stakeholders sampled from 4 CoC sites. Implementation barriers were mapped to theory-informed strategies using the validated CFIR-Expert Recommendations for Implementation Change (ERIC) matching tool. Using the "name it, define it, specify it" method for describing implementation strategies, actions, actors, and action targets were specified for each correlating ERIC cluster and strategy.

Participants included 10 surgeons, 4 cancer liaison physicians, 11 cancer program administrators, and 6 IT engineers. Strategies addressing the most common barriers were 1) determining readiness to implement the SOR; 2) identifying champions to promote the SOR; and 3) having stakeholder discussions to highlight the importance of templated documentation and determine whether the SOR will adequately address this. The common themes across the top strategies were workflow changes, developing an actionable plan, engaging champions, and leveraging champion relationships with other surgeons. Training and educating stakeholders was not a key recommended strategy in our study.

Our study demonstrated that assessment of workflow changes along with local champions and their relationship with surgeons were the most important strategies for successful SOR implementation. Programs may benefit from utilizing these strategies for future SOR implementation and CoC initiatives.