Early planning of small-scale surgical improvement projects: the EPoSSI framework

Variable quality of surgical care is implicated in avoidable deaths, perioperative complications (problems before, during or after surgery), and sub-optimal outcomes. But the impacts of improvement efforts are mixed and sometimes disappointing. This is especially true of local, small-scale quality improvement, which has an important role in supporting better care – but is not always designed or executed well. To address this problem, we developed a framework to guide early planning of small-scale improvement efforts in surgery.  

The framework, designed to be used by local improvement leaders, has been developed through consensus-building exercises with clinicians, patients, and improvement experts. Focusing on the very early stages of project planning, which are known to be crucial to project success, it covers nine domains:

• Choosing the improvement team
• Detailing the problem
• Developing project aims
• Choosing an intervention
• Planning implementation of the intervention
• Planning project monitoring
• Plan end-of-project decision making
• Launch, monitor, finish

The first framework to focus specifically on the early planning phase of a project, EPoSSI outlines key steps, offers suggestions about what to do and what not to do, helps to guide decisions about whether to proceed with projects, and supports preparations for those selected for delivery.