Improving the Implementation of Enhanced Recovery Pathways through Realist Evaluation

Coxon, Astrid (2018) Improving the Implementation of Enhanced Recovery Pathways through Realist Evaluation. Doctoral thesis, University of East Anglia.

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    Abstract

    Aim: This doctoral research aimed to develop a better understanding of the process of implementing Enhanced Recovery Pathways (ERPs) in real-world settings. Through a realist evaluation approach, I aimed to identify which implementation strategies worked, to what extent, for whom, under what circumstances, and why.
    Background: ERPs are an increasingly popular, evidence-based approach to streamlining a broad range of surgeries. When successfully implemented, ERPs have demonstrated an improvement in patient outcomes, including reduced length of stay, reduced pain and improved recovery. However, implementation and staff adherence to ERPs remains inconsistent, limiting the potential benefits of ERPs in practice.
    Methodology: I conducted a realist synthesis of existing UK literature related to ERP implementation research. Building on these findings, I designed a qualitative investigation of a new ERP being introduced in three UK hospitals. This empirical study, conducted over the twelve-month implementation period, involved repeat-interviewing of the co-ordinating change agents, and secondary analysis of ethnographic data. I analysed the entire dataset using thematic analysis.
    Findings: My realist synthesis of ERP implementation literature identified the most commonly used strategies for ERP implementation in UK NHS hospitals, but also highlighted the lack of detailed reporting regarding selection and design of these strategies. My subsequent empirical research tested and refined these programme theories further, identifying a number of critical factors which mediate the successful implementation of ERPs. These included: change agent understanding of role and responsibilities, ward staff readiness to change, and contextual sensitivity of implementation strategy design.
    Conclusions: Although no single, general implementation strategy can be applied to ensure successful ERP implementation across all contexts, the programme theories developed through this research highlight important areas for attention when designing ERP implementation design strategies. Future ERP implementation efforts should prioritise contextually sensitive, evidence-based implementation strategies, in order to maximise pathway adherence and optimise patient care.

    Item Type: Thesis (Doctoral)
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    Depositing User: Bruce Beckett
    Date Deposited: 23 Jul 2018 10:18
    Last Modified: 23 Jul 2018 10:18
    URI: https://ueaeprints.uea.ac.uk/id/eprint/67759
    DOI:

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