Introduction: To promote quality care in hematopoietic stem cell transplantation (HSCT), the
Foundation for the Accreditation of Cellular Therapy (FACT) requires use of evidence-based
standard operating procedures (SOPs) for accreditation in HSCT. Survival rates are improved at
accredited centers. There is a paucity of literature outlining best practices for implementing SOPs
in resource-limited settings. The Vietnamese Pediatric Hematopoietic Stem Cell Transplant and
Cellular Therapies Consortium consists of all 14 hospitals treating children with blood diseases
and cancer in Vietnam. Currently, 8 of these centers provide pediatric HSCT or plan to establish
HSCT programs within the year. Across theses hospitals, use of SOPs for clinical procedures is
variable and none have FACT accreditation.
Aim: This study sought to describe shared barriers and facilitators to implementing SOPs for
pediatric HSCT in five consortium hospitals with established HSCT programs and three
initiating HSCT within a year.
Hypothesis: We hypothesized key barriers would include limited provider knowledge of SOPs,
limited clinician time, lack of incentives to utilize SOPs, and limitations of existing hospital
infrastructure including lack of perceived value by hospital administration and cost of changes
required by SOPs. Additionally, we hypothesized that the lack of established mechanisms for
developing, maintaining, and updating SOPs, could limit SOP use. We expected that providers
would be interested in implementing SOPs for pediatric HSCT to improve patient safety, quality
of care, and outcomes.
Project Design: We conducted individual, semi-structured interviews with nine physicians and
six nurses from consortium hospitals. The Consolidated Framework for Implementation
Research (CFIR) informed the discussion guide and validated approach to rapid qualitative
analysis. Verbatim transcripts were summarized using a CFIR-informed template and data were
consolidated into matrices to identify shared themes.
Results: Barriers and facilitators associated with implementation processes, health system
factors, SOP characteristics, and inner and outer setting dynamics, were shared regardless of
HSCT experience. Implementation barriers included (1) lack of coordinated approach to
developing and distributing SOPs, (2) SOP length and complexity, (3) limited provider time, (4)
variability in access to medications, and (5) inconsistent audits of SOPs. Implementation
facilitators included (1) adaptability of SOPs across hospitals, (2) existing hospital-based
1 UCSF Benioff Children’s Hospital, Pediatrics, San Francisco, CA, United States of America
2 UCSF Benioff Children’s Hospital, Pediatric Hematology/Oncology, San Francisco, CA, United States of America
3 UCSF Helen Diller Family Comprehensive Cancer Center, Global Cancer Program, San Francisco, United States of America,
4 Med2Lab, Inc., NA, Alexandria, VA, United States of America
5 Blood Transfusion Hematology Hospital, Stem Cell Transplantation Department, Ho Chi Minh City, Vietnam,
6 Vietnam National Children's Hospital, Pediatric Oncology Hematology Center, Hanoi, Vietnam