Conducting rigorous implementation evaluations in real word settings: lessons from a consensus approach to...

Area of Science:

• Healthcare implementation science
• Clinical pathway development
• Quasi-experimental study design

Background:

• Limited guidance exists for maximizing learning from single-site implementation studies.
• This study addresses the need for practical insights in implementation science.
• Evaluating standardized perioperative pathways offers transferable lessons.

Purpose of the Study:

• To evaluate a consensus process for developing and implementing standardized perioperative pathways.
• To provide practical insights for conducting rigorous, theory-informed implementation evaluations.
• To generate transferable insights for implementation science in healthcare.

Main Methods:

• A multi-method, quasi-experimental study in an Australian private hospital.
• Six consensus-based surgical care pathways implemented using the Exploration, Preparation, Implementation and Sustainment (EPIS) framework.
• Thematic analysis of interviews and observations, Normalisation Process Theory (NPT) application, and medical record audits for fidelity assessment.

Main Results:

• Standardized perioperative pathways were perceived as acceptable, appropriate, and feasible.
• Pathway fidelity improved in only two of four surgical cohorts.
• Implementation was influenced by EPIS framework elements and NPT mechanisms, with Inner Context and Innovation factors being most influential.

Conclusions:

• This study offers a practical case study for theory-informed implementation evaluations in real-world healthcare.
• Valuable insights are provided for operationalizing implementation science principles.
• Tailoring strategies and co-designing with frontline staff are key to driving local change.