Table 1 Summary of barriers and facilitators identified regarding implementation of remote postoperative monitoring, according to normalisation process theory concepts

Appropriate solution

1. Facilitator: Remote postoperative monitoring fulfils an unmet need, including in other surgical specialties (Cognitive Participation – Legitimation; Reflexive Monitoring – Reconfiguration, Coherence - Communal specification)

2. Facilitator: There is differentiation from routine practice: both existing telemedicine services and in-person assessment (Coherence - Differentiation)

Clinical Benefit

1. Mixed facilitator and barrier: There is a clear clinical benefit, but concern that this may not be shared for all patients (Coherence – Internalisation; Collective Action - Interactional workability & Relational integration).

2. Mixed facilitator and barrier: There is consensus on how the overall effectiveness of remote postoperative monitoring should be determined. However, there are conflicting prioritisation between patients and healthcare staff (Reflexive Monitoring – Systemisation & Individual/communal appraisal).

Stakeholder engagement

1. Facilitator: Stakeholders are generally willing to participate in remote postoperative monitoring, with online communication having been normalised over the pandemic (Cognitive Participation - Initiation).

2. Mixed facilitator and barrier: Patients are motivated to participate and generally feel comfortable with the tasks required, although some may struggle without additional training or support at home (Coherence - Individual specification; Cognitive Participation – Enrolment & Initiation; Collective Action - Skill set workability).

3. Facilitator: Healthcare staff feel they can perform remote triage using information from postoperative monitoring, with a clear consensus that this only required sufficient experience and was not limited to only doctors (Coherence - Individual specification; Cognitive Participation – Enrolment & Initiation; Collective Action - Skill set workability).

Organisational support

1. Facilitator – The COVID-19 pandemic normalised telemedicine services, with examples of nurse-led remote postoperative monitoring are currently supported within local care pathways (Collective Action - Contextual integration).

2. Mixed facilitator and barrier – Integration with existing health information infrastructures (Collective Action - Contextual integration).

3. Barrier – Healthcare staff are overstretched, and so additional and specific staff time would need to be allocated (Collective Action - Contextual integration).

4. Barrier – There is a discrepancy between patient expectations regarding digital health and the capacity of healthcare staff to deliver. Healthcare staff preferred patient-led follow-up and while patients preferred service-led follow-up. Due to limited capacity at present, healthcare staff feel resources should be prioritised to those at highest risk, not all patients (Cognitive Participation – Activation; Collective Action - Contextual integration).