Evidence map›Paper›PMID 41645366›Full record

ArticleImplementation science communications2026

Conducting rigorous implementation evaluations in real word settings: lessons from a consensus approach to perioperative pathway implementation for elective surgery.

Lisa Pagano, Andrew Hirschhorn, Gaston Arnolda, Janet C Long, Emilie Francis-Auton, Jeffrey Braithwaite, Kate Churruca, Louise A Ellis, Peter D Hibbert, Andrew Partington and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Lisa PaganoAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. lisa.pagano@mq.edu.au.ORCID http://orcid.org/0000-0002-2869-5671
Andrew HirschhornFaculty of Medicine, Health and Human Sciences, MQ Health, Macquarie University, Sydney, Australia.
Gaston ArnoldaAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Janet C LongAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Emilie Francis-AutonAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Jeffrey BraithwaiteAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Kate ChurrucaAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Louise A EllisAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Peter D HibbertAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Andrew PartingtonAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Marcus StoodleyFaculty of Medicine, Health and Human Sciences, MQ Health, Macquarie University, Sydney, Australia.
Mitchell N SarkiesAustralian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.

Funding

HCF Research Foundation 52854/00 201640932Medical Research Future Fund Au MRFF2025125National Health and Medical Research Council 2007765National Health and Medical Research Council APP2007970National Health and Medical Research Council GNT1176620National Health and Medical Research Council GNT9100002
6 · The paper itself

Abstract

introductionSingle site quasi-experimental implementation studies provide opportunities to learn about implementation in context. There is limited guidance on how to best utilise these studies to maximise opportunities for learning at scale. This study evaluated the use of a consensus process to develop and implement standardised perioperative pathways, and aimed to provide practical insights on conducting rigorous, theory-informed evaluations that can generate transferable insights for implementation science.

methodsA multi-method quasi-experimental study was conducted in a private hospital in Australia. Six consensus-based surgical care pathways were developed and implemented by different clinical teams, following a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. Implementation outcomes were explored through participant observations (16 h) and semi-structured interviews (n = 9), which were analysed thematically using an interpretive descriptive approach. Normalisation Process Theory (NPT) was then applied to understand the mechanisms of change in greater depth. Pathway fidelity was assessed via medical record audits from a random patient sample (n = 90) from four surgical cohorts.

resultsImplementing standardised perioperative pathways using a multi-faceted consensus-based implementation plan was perceived as acceptable, appropriate, and feasible. However, fidelity to clinical actions improved in only two of four surgical cohorts. Implementation was operationalised through the four generative mechanisms of NPT and was influenced by factors that related to all four constructs and 12/16 elements of the EPIS framework. Factors relating to the Inner Context and the Innovation were most frequently identified as having a greater influence on implementation across all EPIS phases. The implementation plan targeted Collective Action and Coherence to a greater extent than other mechanisms. Participants linked greater uptake and implementation to the importance of co-designing implementation strategies with frontline staff (improving Legitimation and Coherence) and tailoring strategies to specific disciplines.

conclusionsThis project provides a practical case study for how to undertake theory-informed, implementation evaluations in real-world contexts. It offers valuable insights for others seeking to operationalise implementation science principles in everyday healthcare settings including how individual strategies may work to drive local change.

Indexed as

ConsensusEvaluationHealth Services ResearchImplementation sciencePerioperative care

Identifiers

PMID41645366
PMCPMC12977520

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.