Background Enhanced recovery after surgery (ERAS) protocols have existed for the past three decades; these protocols may improve patient outcomes and healthcare costs. Yet, ERAS is difficult to implement, and there has been limited focus on processes used to promote ERAS use. Thus, the aim of this study was to identify and describe the barriers and enablers to implementing ERAS.

Methods In this qualitative descriptive sub-study, semi-structured interviews, guided by the Theoretical Domains Framework, were conducted with surgeons, anaesthetists, and nurses. Interviews were analyzed using inductive and deductive content analysis.

Results Three categories were found, which mapped to 12 domains in the Theoretical Domains Framework. Category 1 ‘realizing the value of ERAS, despite varying levels of exposure and motivation’ showed clinicians' different views and knowledge towards ERAS, with a general belief that ERAS was evidence-based. Category 2, ‘building momentum for ERAS implementation’ outlined strategies to encourage clinicians to practice ERAS. The final category ‘providing resources for ERAS’ illustrated the tools and up-front costs needed for ERAS implementation.

Conclusion Motivational strategies are required to inspire individual clinicians to adopt ERAS. Additionally, resources are needed for ERAS to guide practice and support implementation (i.e., staffing and time), underscoring the need for hospital leadership support.