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Implementation of an Ultra-short-stay Program After Breast Cancer Surgery in Four Hospitals: Perceived Barriers and Facilitators

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Abstract

Background

The objective of this study was to identify barriers and facilitators that professionals see when implementing a program incorporating ultra-short hospital admission in the treatment of breast cancer. Such an intervention is an essential step when designing a strategy for implementation of a care program that is different from established daily routines.

Methods

In a prospective quasi-experimental study qualitative data were collected from four hospitals in the Netherlands between January 2005 and July 2006. Potential barriers and facilitators for successful implementation were extracted from detailed notes of all contacts between the researchers and each participating hospital. Subsequently, these items were categorized according to themes.

Results

Over 40 items were identified. Most barriers concerned organizational and program-related aspects, whereas the most common facilitators addressed organizational issues. Six of the 29 study recommendations were perceived as impeding or facilitating. Thirty of the 40 barriers were mentioned in one hospital only. Several key factors were found that determine the success of implementation of an ultrashort-stay program. Provision of care in the home setting should be assured. Policy makers and insurance companies should acknowledge that multidisciplinary care teams and teams integrating primary and secondary care fulfill important roles in delivering continuity of care. Specific strategies should be set out to convince everybody in the organization about the new ideas, particularly the minority of people who do not agree with the plans.

Conclusions

A set of barriers and facilitators for implementation of the program was described that may be used by any professional preparing to perform breast cancer surgery in an ultrashort–stay facility. The systematic approach that led to this set may be used by any healthcare professional concerned with implementation and consolidation of innovative programs in healthcare in order to enhance the effectiveness of the chosen strategy.

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Acknowledgments

The authors thank all members of the study groups from the participating hospitals and Suzanne von Meyenfeldt for linguistic advice. They thank ZonMw, the Netherlands Organisation for Health Research and Development, & GROW-Research Institute Growth and Development for their financial support.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands

    Mascha de Kok & Maarten von Meyenfeldt

  2. Department of General Practice, Centre for Quality of Care Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands

    Trudy van der Weijden

  3. Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), University Hospital Maastricht, Maastricht, The Netherlands

    Alfons Kessels & Carmen Dirksen

  4. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Cornelis van de Velde

  5. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands

    Jan Roukema

  6. Department of Surgery, Orbis Medical Center, Sittard, The Netherlands

    Fred van der Ent

  7. Department of Surgery, Laurentius Hospital, Roermond, The Netherlands

    Antoine Bell

Authors
  1. Mascha de Kok
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  2. Trudy van der Weijden
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  3. Alfons Kessels
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  4. Carmen Dirksen
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  5. Cornelis van de Velde
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  6. Jan Roukema
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  7. Fred van der Ent
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  8. Antoine Bell
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  9. Maarten von Meyenfeldt
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Corresponding author

Correspondence to Mascha de Kok.

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de Kok, M., van der Weijden, T., Kessels, A. et al. Implementation of an Ultra-short-stay Program After Breast Cancer Surgery in Four Hospitals: Perceived Barriers and Facilitators. World J Surg 32, 2541–2548 (2008). https://doi.org/10.1007/s00268-007-9357-z

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  • DOI: https://doi.org/10.1007/s00268-007-9357-z

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