University of Oulu

Jansson, M. M., Harjumaa, M., Puhto, A.-P., & Pikkarainen, M. (2019). Healthcare professionals’ perceived problems in fast-track hip and knee arthroplasty: results of a qualitative interview study. Journal of Orthopaedic Surgery and Research, 14(1).

Healthcare professionals’ perceived problems in fast-track hip and knee arthroplasty : results of a qualitative interview study

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Author: Jansson, Miia Marika1; Harjumaa, Marja2; Puhto, Ari-Pekka3;
Organizations: 1Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
2VTT Technical Research Centre of Finland, P.O.Box 1100, FI-90571, Oulu, Finland
3Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, P.O.Box 21, FI-90029, Oulu, Finland
4Martti Ahtisaari Institute, Oulu Business School, Oulu University, P.O.Box 8000, FI-90014, Oulo, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2019-09-16


Background: Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty.

Methods: Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used.

Results: Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified.

Conclusions: The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.

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Series: Journal of orthopaedic surgery and research
ISSN: 1749-799X
ISSN-E: 1749-799X
ISSN-L: 1749-799X
Volume: 14
Article number: 294
DOI: 10.1186/s13018-019-1334-3
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: This research has been supported by a grant from Business Finland as part of a project called “Intelligent Customer-driven Solution for Orthopedic and Pediatric Surgery Care”. The funder has not influenced the design, conduct, analysis, or reporting of the study
Copyright information: © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.