Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

Background: To improve perioperative patient safety, guidelines for the preoperative, peroperative, and
postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of
these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline
adherence and to explore what can be learned for future implementation projects in complex organizations.
Methods: We developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. for
classifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument for
measuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviews
with quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. The
target group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on a
five-point Likert scale (which were classified into the seven categories of the framework: factors relating to the
intervention, society, implementation, organization, professional, patients, and social factors), respondents were
invited to rank their three most important barriers in a separate, extra open-ended question.
Results: Ninety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered to
be barriers, relating to social factors (N = 5), the organization (N = 4), the professional (N = 4), the patient (N = 1),
and the intervention (N = 1). An integrated information system was considered an important facilitator (70.4%) as
well as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly all
categories. The most frequently reported barriers were as follows: time pressure (16% of the total number of
barriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%).
Conclusions: We identified a wide range of barriers that are believed to hinder the use of the perioperative safety
guidelines, while an integrated information system and local data collection and feedback will also be necessary to
engage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementation
strategies. These results may also be of relevance for guideline implementation in general in complex organizations.
Trial registration: Dutch Trial Registry: NTR3568.
Keywords: Guideline adherence, Implementation, Implementation barriers, Implementation facilitators, Patient
safety, Perioperative care