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The Orthopaedic Forum   |    
Overcoming Resistance to Implementation of Integrated Care Pathways in Orthopaedics
Blaine T. Manning, BS1; Charles D. Callahan, PhD, MBA, FACHE2; Brooke S. Robinson, MPH1; Daniel Adair, MD3; Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM1
1 Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794. E-mail address for K.J. Saleh: ksaleh@siumed.edu
2 Memorial Health System, 701 North 1st Street, Springfield, IL 62781
3 Orthopaedic Group at Springfield Clinic, 800 North 1st Street, 1st Floor, Springfield, IL 62702
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jul 17;95(14):e100 1-6. doi: 10.2106/JBJS.L.01312
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Abstract

Abstract: 

The future of orthopaedic surgery will be shaped by unprecedented demographic and economic challenges, necessitating movement to so-called “second curve” innovations in the delivery of care. Implementation of integrated care pathways (ICPs) may be one solution to imminent cost and access pressures facing orthopaedic patients in this era of health-care accountability and reform. ICPs can lower costs and the duration of hospital stay while facilitating better outcomes through enhanced interspecialty communication. As with any innovation at the crossroads of paradigm change, implementation of integrated care pathways for orthopaedics may elicit surgeons’ concern on a variety of grounds and on levels ranging from casual questioning to vehement opposition. No single method is always effective in promoting cooperation and adoption, so a combination of strategies offers the best chance of success. With a special focus on total joint replacement, we consider general patterns of resistance to change, styles of conflict, and specific issues that may underlie orthopaedic surgeon resistance to implementation of integrated care pathways. Methods to facilitate and sustain orthopaedic surgeon engagement in implementation of such pathways are discussed.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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