TABLE III.

Findings from non-participant observation and documentary evidence

Evidence type	Findings by theme
Nonparticipant observation (n=6)
	Innovation–values fit: synoptic reporting aligns with values, goals, interests, and strategic directions
	Surgeons indicated willingness to use innovation; most stated that they saw value in new tool, but the key was to make the system as easy to use as existing practice Most surgeons expressed interest in standardized data capture and the implications for performance monitoring and research; some questioned who “owned” the data; others expressed skepticism related to promises from other initiatives of similar capabilities that had not yet materialized
	Flexibility with the innovation and implementation
	Training sessions were customized to meet the particular surgeon’s or department’s needs: some sessions were one-on-one, others were small-group; all occurred on the surgeon’s “turf”
	The innovation is not flawless; it will require continual review and revisions
	All surgeons had some questions related to specific data elements and their relevance to the operative report; most also suggested at least 1 or 2 elements that they felt should be in the template
	Strengthening the implementation climate
	Trainers were responsive to surgeons’ questions and requests regarding the templates or its elements, minimizing initial issues and concerns
	The information technology (it) lead joined all training sessions, either in person or by teleconference; his presence was helpful in addressing technical issues and concerns
	Small-group training appeared to work well in terms of contributing a clinical perspective, because training was conducted by nonclinical trainers—for example, initial skepticism concerning particular elements could be talked through with colleagues and (sometimes) resolved
	Resource needs and availability for implementation
	Ongoing 24/7 technical support will be required during WebSMR rollout to minimize technology-related challenges Additional tools and resources are needed to realize the potential of this system in terms of data mining and performance monitoring and feedback
Documentary evidence
	Innovation–values fit: synoptic reporting aligns with values, goals, interests, and strategic directions
	The national evaluation found that surgeons using the innovation believe that synoptic reporting better prepared them for surgery and that the tool will revolutionize data capture and lead to improved quality of care and patient outcomes
	The main facilitator to adoption was the prospect of outcomes reporting and data mining; yet, one of the main project challenges was the lack of tools and resources for measuring and reporting outcomes
	Flexibility with the innovation and implementation
	Each province’s template was customized for local implementation—a step that was crucial for local buy-in and adoption Accepting that each jurisdiction was unique and customizing the tool and training to that jurisdiction was critical to the implementation and will remain so with further rollout
	The innovation is not flawless; it will require continual review and revisions
	Barriers to adoption and use were largely related to the innovation itself and included ease of access and use, it-related challenges (forgotten passwords, login difficulties), complex cases, and complexity or length of the tool
	Strengthening the implementation climate
	Change management strategies occurred broadly (not just with surgeons) and was tailored depending on user needs and preferences All provinces emphasized that training should not be underestimated; the more training, the better the implementation experience Facilitators to adoption and use included customization of the final report for end users and system access improvements (for example, putting laptops in operating theatres)
	Resource needs and availability for implementation
	Nationally, a key success factor to WebSMR deployment was having key expert (it) resources
	The Nova Scotia team perceived that the project was underfunded from both the it and the project (clinical) lead perspectives; the project lead diverted funds from his stipend to support the necessary it work for the project’s implementation
	Partner engagement: early and ongoing contact with partners was key to implementation
	The early engagement of partners, especially surgeons, was viewed as a critical success factor for implementation
	At all pilot sites, implementation required engagement with many different stakeholders
	The innovation’s limits and abilities should be defined from it, information management, and privacy perspectives, and not just surgeon perspectives
	Surgeon champions and involvement
	Surgeon involvement and leadership was a critical factor for success; included were surgeon enthusiasm and a willingness to work together on a national scale to create pan-Canadian data standards and templates