Cognitive Aids for Operating Room Crises - A thematic analysis of implementer experiences

BackgroundStrategies for the implementation of evidence-based interventions have proliferated, but it remains unclear how these strategies are operationalized for different types of interventions and contexts. Here, we examine seven implementation strategies--initially developed for implementing the World Health Organization (WHO) Surgical Safety Checklist (SSC)--for implementing cognitive aids for operating room (OR) crises. MethodsWe conducted semi-structured interviews with implementers of these aids exploring the use of each of the strategies previously studied with WHO SSC implementation as well as barriers and facilitators to implementation. We conducted a thematic analysis to identify and describe the use of the strategies. We mapped barriers and factors helping facilitate (facilitators) onto corresponding constructs from the Consolidated Framework for Implementation Research. ResultsWe conducted interviews with 37 implementers across the United States. Most interviewees identified similar strategies in their implementation process, and none offered additional strategies that fell outside existing categories. There was substantial variation among implementers in how the strategies were deployed. Many of the barriers and facilitators were common across implementations. ConclusionInterviewees used a core set of strategies to implement cognitive aids for OR crises, but there was substantial variation in how implementers used these strategies, suggesting the flexibility of the strategies and the value of deliberately adapting strategies to local context. The transferability of implementation strategies from the WHO SSC to other OR-based cognitive aids demonstrates the utility of informing novel implementations with prior successful ones that share similar attributes with respect to intervention and/or context.