Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room

Abstract

Background: More knowledge is needed on the preconditions and circumstances for leading implementation of evidence based practice in the operating room (OR). Effective leadership support is critical to enhance the provision of safer care. The aim of this study was to explore managers' and clinical leaders' experiences of implementing evidence-based practice to increase patient safety in the operating room. Methods: The study had a qualitative descriptive design. In all, 25 managers were interviewed, with different surgical specialities (orthopedics, general and pediatric surgery) and operating room suites, from eight hospitals and 15 departments. Results: The organizational structures were defined as key obstacles to implementation. Specifically, lack of a common platform for cooperation between managers from different departments, organizational levels and professional groups impeded the alignment of shared goals and directions. In cases where implementation was successful, well-functioning and supportive relationships between the managers from different professions and levels were crucial along with a strong sense of ownership and control over the implementation process. Whilst managers expressed the conviction that safety was an important issue that was supported by top management, the goal was usually to "get through" as many operations as possible. This created conflicts between either prioritizing implementation of safety measures or production goals, which sometimes led to decisions that were counter to evidence-based practice (EBP). While evidence was considered crucial in all implementation efforts, it might be neglected and mistrusted if hierarchical boundaries between professional subgroups were challenged, or if it concerned preventive innovations as opposed to technical innovations. Conclusions: The preconditions for implementing EBP in the OR are suboptimal; thus addressing leadership, organizational and interprofessional barriers are of vital importance.

The Intervening Conditions and the Strategies for Effectively Implementing of the Surgical Safety Guideline in the Hospitals

“…Tables 1 and 2 present the results of content analysis of qualitative articles. According to Table 1, the intervening conditions of effectively implementing the surgical safety guideline were categorized in 21 sub-categories and three categories as follows: technical factors (1, 13, 21, 28, 30, 31, 33, 35-38, 40-43, 46, 49), human factors (19,21,24,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42), and managerial-organizational factors (21, 24, 28, 30, 31, 33, 35-42, 44, 46, 47, 50). They have been categorized in ten, eight and three sub-categories, respectively.…”

Prerequisites for safe intraoperative nursing care and teamwork—Operating theatre nurses’ perspectives: A qualitative interview study

“…Per the present study, healthcare personnel working in large hospitals with several departments experience difficulties in getting adequate information for patient care and surgery. A possible cause is the way departments are organised, like silos or with different administrative systems, goals and intentions (Erichsen Andersson et al, ). This may endanger predictability of the patients’ scheduling for a procedure, especially in big teaching or university hospitals where OTNs are specialised in certain surgical procedures or assigned to specialised units (Levine & Dunn, ).…”

“…This fosters "silo-thinking," which can lead to fragmented goals and objectives for patient care (ibid. ), and a risk of different goals and priorities for the professionals as reported by Erichsen Andersson, Gifford, and Nilsson (2015).…”

“…This fosters “silo‐thinking,” which can lead to fragmented goals and objectives for patient care (ibid. ), and a risk of different goals and priorities for the professionals as reported by Erichsen Andersson, Gifford, and Nilsson (). The care in operating theatres (OT) is expensive and requires efficient management based on correct information about patients’ health situation, planning and scheduling for surgery.…”

Experiences of nurses implementing evidence-based practice in an acute care setting in Nigeria: A qualitative study

“…There were indications that the national CGPs were not properly adapted prior to implementation which might have led nurses to consider it as an imposed change. Top down is interlinked with failed implementation processes and can impeded innovativeness within the healthcare setting, [32] just as drawbacks exist when evidence (practice guidelines) is incompatible with the local context where implementation occurs. [1] Adequate understanding of the context of implementation is crucial in determining successes of what is to be implemented.…”