title: Implementation of an ultra-short-stay program after breast cancer surgery in four hospitals: perceived barriers and facilitators.
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.
authors.affiliation: Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. M.dekok@ah.unimaas.nl
authors.forename: Mascha
authors.initials: M
authors.lastname: de Kok
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Alfons
authors.initials: A
authors.lastname: Kessels
authors.forename: Carmen
authors.initials: C
authors.lastname: Dirksen
authors.forename: Cornelis
authors.initials: C
authors.lastname: van de Velde
authors.forename: Jan
authors.initials: J
authors.lastname: Roukema
authors.forename: Fred
authors.initials: F
authors.lastname: van der Ent
authors.forename: Antoine
authors.initials: A
authors.lastname: Bell
authors.forename: Maarten
authors.initials: M
authors.lastname: von Meyenfeldt
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies