The document discusses the importance of implementation science in healthcare, emphasizing that understanding and applying evidence-based practices is crucial for improving patient outcomes. It outlines barriers and facilitators to effective intervention delivery, as well as strategies to promote successful adoption and sustainability of new practices in the operating theatre. Additionally, it highlights the need for collaboration across departments and provides a structured approach to implementing change through Kotter's 8-step model.

1. Changing Behaviour in the
Operating Theatre
Ed Fitzgerald
@DrEdFitzgerald

2. “We’ve failed to view delivery of health care as a science.
The tasks of medical science fall into three buckets:
One is understanding disease biology
One is finding effective therapies
And one is ensuring those therapies are delivered effectively.
That third bucket has been almost totally ignored by research funders,
government, and academia.
It’s viewed as the art of medicine.”
Peter J. Pronovost
Intensive Care specialist physician
Johns Hopkins

3. J R Soc Med December 2011 vol. 104 no. 12 510-52

4. What’s implementation about?
“Implementation science is the study and
application of methods to promote integration
of evidence-based research findings into health
care policy and practice”
What can be
achieved in theory
What happens in
practice
Brooke et al, JAMA Surgery, 2015;150(10):1006-1007
GAP

5. Why is it important?
Despite abundant evidence of the efficacy of life-saving
interventions, there is little understanding of how to deliver
those interventions effectively.
Implementation research takes what we know
and turns it into what we do
1. What are the barriers and facilitators?
2. How to make it sustainable?
3. How to accelerate adoption?
4. How to scale it up?
5. What strategies to use?

6. Why is it important for us?
1. Selecting the intervention
2. Designing the trial
3. Implementing the trial
4. Scaling the trial
5. Changing practice

7. How to bridge the gap?
Implementation methods and strategies promote
successful uptake of new interventions into practice
Brooke et al, JAMA Surgery, 2015;150(10):1006-1007
Consolidated Framework for Implementation Research

8. Factors to consider
• Available resources to support implementation
• Infrastructure
• Workforce
• Quality of communication within the hospital/teams
• Leadership
• Capacity for change
• Commitment to change
• Upfront capital investment
• Training content and design

9. Peters et al. Implementation research in health. World Health Organisation.

10. What does it look like?
• 1 month preparation
• Local implementation team
• Reps from all departments
• Week long launch period
• On site expert assistance
• Demonstration
• Role plays
• Active encouragement
• Small group orientation
• Graduated rollout over 1 month
• 3 operating rooms per week
• Intraoperative coaching

11. Change
takes
time

12. What are your barriers?
Change
Training
Local
resources
Insight
Professional
culture Hierarchy
InertiaEngagement
Support
structures

13. Kotter's 8-Step Change Model
2. Form a powerful coalition
3. Create a vision for change
4. Communicate the vision
5. Remove obstacles
6. Create short-term wins
7. Build on the change
8. Anchor the change in practice
1. Create urgency

14. Next steps to consider
Understand
intervention:
What
happens?
Understand
processes to
make it
happen
Understand
setting in
which is
happens
Understand
the people
who make it
happen
Local process
mapping
Stepwise
analysis
Cultural
setting
Physical
setting

15. Human behaviour flows from three
main sources:
Desire, emotion, and knowledge.
Plato

16. www.globalsurg.org
@GloablSurg
Dr Ed Fitzgerald
jeffitzgerald@gmail.com
@DrEdFitzgerald