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Enhanced recovery program implementation: an evidence-based review of the art and the science

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Abstract

Background

The benefits of enhanced recovery program (ERP) implementation include patient engagement, improved patient outcomes and satisfaction, better team relationships, lower per episode costs of care, lower public consumption of narcotic prescription pills, and the promise of greater access to quality surgical care. Despite these positive attributes, vast numbers of surgical patients are not treated on ERPs, and many of those considered “on pathway” are unlikely to be exposed to a majority of recommended ERP elements.

Methods

To explain the gap between ERP knowledge and action, this manuscript reviewed formal implementation strategies, proposed a novel change adoption model and focused on common barriers (and corollary solutions) that are encountered during the journey to a fully implemented and successful ERP. Given the nature of this review, IRB approval was not required/obtained.

Results

The information reviewed indicates that implementation of best practice is both a science and an art. What many surgeons have learned is that the “soft” skills of emotional intelligence, leadership, team dynamics, culture, buy-in, motivation, and sustainability are central to a successful ERP implementation.

Conclusions

To lead teams toward achievement of pervasive and sustained adherence to best practices, surgeons need to learn new strategies, techniques, and skills.

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Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit #1484, Houston, TX, 77030-4008, USA

    Thomas A. Aloia

  2. New York-Presbyterian Hospital Columbia University Medical Center, New York, NY, USA

    Deborah S. Keller

  3. Northwell Health Lenox Hill Hospital, New York, NY, USA

    Rebecca B. Kowalski

  4. Northern Light Health - Eastern Maine Medical Center, Bangor, ME, USA

    Henry Lin

  5. W. P. Carey School of Business at Arizona State University, Tempe, AZ, USA

    Margaret M. Luciano

  6. Rush University Medical Center, Chicago, IL, USA

    Jonathan A. Myers

  7. NYU Langone Health, New York, NY, USA

    Prashant Sinha

  8. Stony Brook University, Stony Brook, NY, USA

    Konstantinos Spaniolas

  9. Mayo Clinic College of Medicine, Phoenix, AZ, USA

    Tonia M. Young-Fadok

Authors
  1. Thomas A. Aloia
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  2. Deborah S. Keller
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  3. Rebecca B. Kowalski
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  4. Henry Lin
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  5. Margaret M. Luciano
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  6. Jonathan A. Myers
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  7. Prashant Sinha
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  8. Konstantinos Spaniolas
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  9. Tonia M. Young-Fadok
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Contributions

Authors are listed alphabetically and all equally participated in the Design, Writing, Editing, and Final Approval of this manuscript.

Corresponding author

Correspondence to Thomas A. Aloia.

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Disclosures

Drs. Aloia, Keller, Kowalski, Lin, Luciano, Myers, Sinha, Spaniolas, and Young-Fadok have no conflicts of interest or financial ties to disclose.

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Aloia, T.A., Keller, D.S., Kowalski, R.B. et al. Enhanced recovery program implementation: an evidence-based review of the art and the science. Surg Endosc 33, 3833–3841 (2019). https://doi.org/10.1007/s00464-019-07065-6

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