Description
Introduction/BackgroundEvidence-informed perioperative pathways that standardise surgical care improve patient outcomes and promote consistent quality. However, substantial variation in surgical care delivery persists globally. A key challenge is fostering agreement between autonomous clinicians. Consensus discussions hold potential as a strategy to foster agreement, yet how consensus discussions work in practice is poorly understood. T his study examined how clinicians build consensus and how these discussions influence the implementation of standardised perioperative pathways.
Method
A qualitative, modified grounded theory study was conducted in one private hospital in metropolitan Sydney, Australia. Thirty-one participants from clinical disciplines and hospital management/leadership were recruited by convenience sampling. Data were collected from nine semi-structured interviews and 15 participant observations of meetings related to consensus development or implementing the perioperative pathways. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Interviews and field notes were recorded and transcribed verbatim. Data were analysed in NVivo.
Results/Findings
Analysis revealed several determinants crucial for building consensus which were integrated into a model. Mechanisms for reaching agreement were identified which formed a ‘consensus’ hierarchy . Seeking evidence to support decision-making emerged as the primary driver of consensus discussions. Strong evidence in support of a practice facilitated swift decision-making. Where there was ambiguous evidence for a pathway component, clinicians based their decisions on a desire for professional autonomy, consideration of how their peers practice, patient preferences, external requirements, or feasibility of implementing the pathway component. Multidisciplinary engagement, streamlining workflows, highlighting the value of standardising pathways and using targeted behaviour change methods were found to promote adoption and successful implementation.
Implications/Key Message
Perioperative pathways can be successfully developed using consensus discussions and understanding how clinicians reach consensus is essential to maximise implementation efforts. This model provides a valuable blueprint for healthcare organisations seeking to optimise the informal consensus process for developing and implementing perioperative pathways.
| Period | 5 Dec 2024 |
|---|---|
| Event title | Health Services Research Conference 2024 |
| Event type | Conference |
| Location | Brisbane, AustraliaShow on map |