The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study

Margot E Lodge; Jugdeep Dhesi; David Jh Shipway; Philip Braude; Catherine Meilak; Judith Partridge; Nadine E Andrew; Velandai Srikanth; Darshini R Ayton; Chris Moran

doi:10.1186/s12913-024-10844-0

The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study

BMC Health Serv Res. 2024 Mar 15;24(1):345. doi: 10.1186/s12913-024-10844-0.

Authors

Margot E Lodge^{1

2

3}, Jugdeep Dhesi^{4

5}, David Jh Shipway^{6

7}, Philip Braude⁶, Catherine Meilak⁸, Judith Partridge^{4

5}, Nadine E Andrew^{1

2}, Velandai Srikanth^{1

2

9}, Darshini R Ayton^#^{10

11

12}, Chris Moran^#^{1

2

3

9

13}

Affiliations

¹ National Centre for Healthy Ageing, Melbourne, Australia.
² Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia.
³ Alfred Health, Melbourne, Australia.
⁴ Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵ King's College London, London, UK.
⁶ CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, UK.
⁷ University of Bristol, Bristol, UK.
⁸ East Kent Hospitals University NHS Foundation Trust, Canterbury, UK.
⁹ Peninsula Health, Frankston, Australia.
¹⁰ National Centre for Healthy Ageing, Melbourne, Australia. darshini.ayton@monash.edu.
¹¹ Health and Social Care Unit, Monash University, Melbourne, Australia. darshini.ayton@monash.edu.
¹² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. darshini.ayton@monash.edu.
¹³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

^# Contributed equally.

Abstract

Background: The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK.

Methods: A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).

Results: Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.

Conclusions: Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.

Keywords: Implementation science; Older people; Perioperative care; Qualitative research.

MeSH terms

Aged
Humans
Perioperative Medicine*
Qualitative Research