Institution-wide Implementation Strategies, Finance, and Administration for Enhanced Recovery after Surgery Programs

ERAS® is more than a collection of evidence-based interventions-it is a collaborative approach to surgical care delivery that leverages a culture of trust, frank discussion, and iterative improvement based on real-time auditing and feedback that has been repeatedly shown to simultaneously improve quality while decreasing costs. Hospitals and health care systems in the United States and internationally face similar pressure to improve the value of surgical care delivery, and ERAS® can be a powerful tool to help meet this challenge. For the ERAS® champion, understanding the local implications of this shifting health care environment can help them position ERAS® as a critical, highpriority institutional initiative worthy of investment. Carefully modeling the financial and clinical benefits, their attendant costs, and to whom in an organization each accrue can sidestep silo mentalities based on the fragmented budgeting and accounting systems present in most hospital systems globally. Creating a culture of transparency and open feedback of process data, coupled with a thoughtful and inclusive style of leadership that flattens hierarchies is the final step to creating a lasting ERAS® implementation that continually evolves to incorporate the latest interdisciplinary interventions that improve patient outcomes and reduce wasteful resource utilization.