Table 1

EPOCH implementation strategies; desired outcomes, resources and use in individual hospitals

Desired outcomesProposed implementation strategiesQuIP activities and resourcesImplementation strategy usage during the intervention period – questionnaire itemsImplementation strategy usage during the intervention period – questionnaire responses
Motivation for change created among stakeholders and improvement goals clearly understoodQI leads hold a stakeholder meeting after activation
(strategy 1).

  1. Preactivation checklist (providing guidance for planning of stakeholder meeting).

  2. Evidence for QI and need for change provided.

  3. Presentation on achieving engagement.

 Stakeholder meeting
Did you hold a stakeholder meeting as one of your QI activities? For example, a meeting for all professionals involved in patient care.

  • 55% (41/75): yes.

  • 45% (34/75): no.

Interprofessional collaboration fosteredEach hospital to form an interprofessional improvement team (strategy 2)

  1. Team approach promoted.

  2. QI leads encouraged to invite colleague to EPOCH meetings.

  3. EPOCH VLE open to all local QI team members.

 QI team formation
At your site, was a formal team created to work on QI activities related to EPOCH?

  • 60% (46/77): yes.

  • 27% (21/77): no.

  • 13% (10/77): other (comments indicated informal teams often existed).

Shared view of current performance created (‘situational awareness’)QI leads analyse their own data (NELA data±case note reviews and local audit data) and feed this back to colleagues regularly
(strategy 3).

  1. Case-note review tool.

  2. Training on data for improvement.

  3. Training on how to access and analyse NELA data.

  4. Excel workbook programmed to create run charts from NELA data.

  5. Secure data sharing site created on VLE.

 Data collection and analysis
After starting EPOCH, did you or your colleagues download and analyse your local NELA data?
If yes, how frequently did you do this?

  • 79% (61/77) : yes.

  • 21% (16/77) : no.

  • 43% (26/61) : analysing. data monthly or bimonthly.

  • 57% (35/61) : analysing data less frequently.

Frontline teams develop and use basic QI skills to effect changeQI leads and other team members:
Use time-series charts (‘run charts’)
(strategy 4).
Use the plan–do–study–act (PDSA) cycles
(strategy 5).
Segment the patient pathway
(strategy 6).

  1. Introduction to QI skills training provided.

  2. Links to further reading and training resources for QI.

  3. Telephone and email support.

 Run charts
When analysing data, did you use run-charts?
PDSA approach
Did you or your colleagues use the ‘Plan Do Study Act’ cycle approach during your QI activities?
Pathway segmentation
Please indicate statement most closely fits your hospitals improvement or implementation activity during EPOCH.

  • 92% (56/61): used run charts to analyse data.

  • 61% (45/74): yes, sometimes.

  • 5% (4/74): yes, often.

  • 34% (25/74): no.

  • 22% (17/77) : we introduced a single pathway of care (across preoperative, intraoperative and postoperative phases).

  • 32% (25/77): we introduced separate pathways or care bundles for the perioperative phases.

  • 40% (31/77): we focused on introducing individual/separate interventions.

  • 5% (4/77): other.

  • EPOCH, Enhanced Peri-Operative Care for High-risk patients; NELA, National Emergency Laparotomy Audit; QI, quality improvement ; QuIP, quality improvement programme; VLE, virtual learning environment.