title: Barriers and facilitators to implementation of the Liverpool Care Pathway in the Netherlands: a qualitative study.
abstract: OBJECTIVE
  The Liverpool Care Pathway (LCP) is a quality instrument for the dying patient. This study evaluates barriers and facilitators to its implementation in the Netherlands from the perspective of key stakeholders, to inform future implementation processes.
  
  
  METHODS
  An interview study was conducted among 28 stakeholders involved in implementation of the LCP in the Netherlands, followed by a consecutive focus group with 8 interviewees to discuss and validate the findings of the interview study. Interviews were conducted by telephone and the notes taken during the interviews and focus group were transcribed into non-verbatim transcripts. Data collected during the interviews and focus group were evaluated using thematic analysis.
  
  
  RESULTS
  According to the stakeholders, a context analysis prior to implementation was useful to find the appropriate orientation to adequately motivate healthcare professionals as well as management. The main contributing factors were the quality of the LCP (including its evidence-based character and completeness), and that it fitted the needs of healthcare professionals. During the implementation phase, a multidisciplinary project team, competent support and continuous monitoring were identified as important facilitators. Furthermore, for successful implementation, a facilitator working in liaison with others was helpful. To guarantee sustainability of the use of the LCP, it was important to disentangle tasks from the project leader and formally integrate these into the quality systems of the organisation.
  
  
  CONCLUSIONS
  The Dutch experience with large-scale implementation of the LCP has identified important barriers and facilitators to the implementation of a quality instrument within palliative care. To successfully implement such a promising instrument, liaison with others is important. The sense of being part of a process of improvement is valuable, while consolidation of this idea contributes to successful implementation.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Natasja
authors.initials: N
authors.lastname: Raijmakers
authors.affiliation: Palliative Care, Comprehensive Cancer Centre, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Dekkers
authors.affiliation: Palliative Care, Comprehensive Cancer Centre, The Netherlands.
authors.forename: Cilia
authors.initials: C
authors.lastname: Galesloot
authors.affiliation: Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Lia
authors.initials: L
authors.lastname: van Zuylen
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D017144:Focus Groups; D006282:Health Personnel; D006284:Health Plan Implementation; D006801:Humans; D007400:Interprofessional Relations; D009426:Netherlands; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
keywords: Service evaluation