Bevorderende en belemmerende factoren voor implementatie van preoperatieve screeningspoliklinieken een verkennende studie in negen ziekenhuizen

Despite the (qualitatively and quantitatively) proven cost-effectiveness of timely outpatient preoperative evaluation (OPE), leading to improved preoperative care, many Dutch hospitals have not (yet) implemented an OPE clinic. Hence, a large study among all Dutch hospitals has recently been started to determine which factors facilitate or limit the implementation of OPE clinics. This article describes the results of the first qualitative and explorative phase of this nation-wide study. After defining the potential facilitating and limiting factors based on extensive literature search, we empirically tested the presence or absence of these factors in 9 specifically selected hospitals (three with, three without and three with a partial OPE clinic). This was done by face-to-face interviews with representatives of 5 different parties which are involved in the implementation of OPE clinics. These parties are: the board of directors, the medical staff, anaesthesiologists, internists and surgeons. Financing and motivation (co-operation) were mentioned as major factors influencing the implementation of an OPE clinic. Underlying problems that were mentioned, were budget transfer between specialists, loss of income and turf battles. Logistic and organisational preconditions were also mentioned as important factors for successful implementation of an OPE clinic. The results of this explorative study offer an overview of the likely facilitating and limiting factors for implementation of an OPE clinic. These mentioned factors will be tested subsequently in all Dutch hospitals. The study will eventually contribute to the definition of advises and guidelines for successful implementation strategies for OPE clinics, and for health innovation projects in general.