Table 5 Coherence—supporting quotes

Champion fit

Actually I was interested in the Fast Track before the others were interested. We started doing this at [hospital] with Surgeon X and Surgeon Y before everybody started doing it. I think we were probably doing it probably for about two or three years before everybody started. (Anaesthesiologist)

Basically we started a similar programme a few years ago and that’s still in progress - Enhanced Recovery Colon Surgery. So it was called ERCS and we had a little bit of funding as well to start it in the hospital and there were a few uptake from other surgeons. It was difficult to convince them at that time. And so it became almost natural, when ERAS came in, they suggested that I take the lead on this one. (Surgeon)

Buy-in

The six surgeons who are seeing patients, they’re all engaged in this. I think one of the greatest things is that people know that ERAS is not a crazy thing, it’s structural. You can accommodate people. There are 10 interventions that you do, but if you cannot do ten, you can do only 5. But just do 5 and try to accommodate people and that way people feel happy with that. (Surgeon)

Luckily it was easy to implement our part from an anesthesia perspective because the guidelines fell into what we do anyway and we do have the resources, the manpower, and the knowledge for the most part to implement these and the guidelines were no surprise to anyone. (Anaesthesiologist)

Resistance

I think that was one of the biggest challenges was feeding patients early because for so many nurses, they associated that with patients developing ileus. I think some of them still do. They feel that the patients who develop an ileus, it must be because we fed them early. (Nurse)

There are a lot of people who are very critical or skeptical of the value of Gabapentin and are concerned that it makes the patient sleepier post-op. And you know, it’s kind of an issue of personal preference. I think the evidence for Lidocaine infusions is very strong and most people do as well but again, you just have to read the literature to know that. (Anaesthesiologist)

Team cohesion

Our surgeon champion’s great. I send him an email. He’s emailing me when he's on bloody holidays last week. I didn’t realize he was away. (Nurse)

I think the interaction between the surgeon champion and nurse champion and myself have been very very good. I think the team has really helped, I think ERAS has really helped the teamwork. (Anaesthesiologist)

The only challenge that I saw personally was trying to get our anesthesia champion interested enough to get his group onboard so that’s where the challenges were from my viewpoint. (Surgeon)