OR Manager - June 2020 - 19

Enhanced Recovery After Surgery
SPECIAL SERIES
Enhanced Recovery After Surgery (ERAS) is a set of evidence-based
clinical recommendations that, when combined,
standardize care to improve patient outcomes. In this series
of articles, which began with the October 2019 issue of OR
Manager, leaders from Virginia Commonwealth University
Health System in Richmond have described their experience
with implementing ERAS and the resulting improvements.
This article examines the role of governance and leadership
in facilitating the growth and success of a hospital-wide
ERAS program through the lens of the seven
concepts of change: resistance, senders and receivers
of messages, authority for change, value systems, incremental
versus radical change, the right answer is not
enough, and change is a process.1
Hospital-wide ERAS adoption hinges on leadership support
nhanced Recovery After Surgery
(ERAS) is arguably the greatest
advancement in surgery in the
last 20 years. But even healthcare leaders
who support the use of ERAS to
achieve better outcomes can find it
daunting to implement the protocols
throughout their hospital systems.
Standardizing practices across areas
that have historically functioned as
silos can raise concerns about whether
the evidence supports these changes,
whether changes are locally and institutionally
supported, and whether
changes may make it harder to meet
other performance expectations.
At Virginia Commonwealth University
Health System (VCU Health) in Richmond,
starting with a focused implementation
in one surgical subspecialty
(colorectal surgery) led by a well-supported
champion and then presenting
the improved outcomes data to other
specialties allowed us to demonstrate
the real-world impact ERAS can have
on patient outcomes. We were able to
address concerns and overcome resistance
to achieve lasting change. (Details
of how ERAS was implemented and
the improved outcomes that resulted
are described in " Providing cost-benefit
analysis for ERAS-related solutions, " OR
Manager, January 2020, 26-27.)
E
Expect resistance and plan ahead
Difficulties with ERAS implementation
have been described in the literature.
Some of the main barriers include:
* time constraints
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* opposition from colleagues
* logistical reasons such as composing/distributing
memos and devising
care maps
* the need to provide continuous training
* the additional work required to implement
ERAS
* lack of leadership and administrative
support
* resistance from providers, resistance
to change in general, and
even resistance from administrators.2,
3
Despite general agreement with the
clinical principles of ERAS, we have encountered
pockets of resistance in the
form of both active resisters-those
who voice opposition-and passive resisters-those
who fail to change by
not engaging in the design or participating
in the implementation of protocols.
It is important to understand the
emotional and personal factors that
contribute to resistance and prepare accordingly.
At VCU Health, a key strategy
to overcoming resistance has been to
ensure a variety of providers and clinicians
are provided the opportunity to
participate in designing the change.
Know your key senders and
understand your receivers
There are many factors that influence
what the receiver of a message hears.
According to Prosci, a leading provider
of change management publications
and training, the most important senders
are the senior leaders and direct supervisors.1
Senior leaders bear the responsibility
of communicating why ERAS
is important, the risk of not implementing
it, and how ERAS aligns with the
vision and direction of the organization.
As with any complex, multidisciplinary
healthcare model, success is
dependent upon a comprehensive, evidence-based
strategy that aligns with
the organization's mission, vision, and
strategic goals. Stated strategic goals
solidify the vision of the organization, allowing
and supporting a common message
to the team members, providers,
leaders, and board members.
Direct supervisors are best at addressing
how ERAS impacts the individual
and the team, the effect on daily
work, and how individuals will benefit.
Key messages here include how a wellimplemented
ERAS program improves
team efficiency, fosters a better work
environment, reduces OR cancellations
and delays, and reduces the amount
of caregiving time and labor needed for
each patient.
By providing communications using
standard formats and channels at regular
intervals, we have better engaged
team members in the change. Examples
include a weekly one-page update
sent via email with a printable attachment,
regular presentations at grand
rounds, and cascading message kits.
Establish sponsorship that is
active and visible
In healthcare systems with an increased
focus on value, many strateContinued
on page 20
OR Manager | June 2020
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OR Manager - June 2020

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