Five principles to prioritise in small-scale surgical quality improvement: a qualitative study of the views of surgical improvement leaders

Why it matters

A lot has been invested into efforts to improve the quality and safety of healthcare, but these improvement efforts are not always evaluated properly. When these efforts are evaluated, the results are often disappointing.

Many improvement efforts are ‘small-scale’ – they happen within single healthcare organisations, are often led by people with many other responsibilities and no specialised training in improvement and can only call on limited resources.

Naturally, this type of improvement effort will attract less attention than a well-funded, large-scale initiative might, but small-scale improvement initiatives still have plenty of potential to be able to generate improvement – especially in quick response to a pressing issue. They can also provide learning that could be useful elsewhere.

This study, which is part of a wider project looking at how best to implement small-scale improvement initiatives, asked people with experience of improvement in the field of surgery to identify the things likely to make the greatest difference to improvement efforts when doing improvement on a small scale – when time, expert input and other resources may be tight.

What we found

Participants in the study identified five areas in particular where careful planning and delivery can make the most difference to the potential impact of small-scale improvement.

1. High-quality planning before a project starts is vital – even small-scale initiatives need careful planning, and resisting the urge to leap into action can pay dividends later.
2. Fully understanding the problem which the project aims to solve – this makes sure that the aims of any improvement project and the approach it takes are fit for purpose.
3. Making sure that improvement efforts fit within the available time, resources, and local context helps to create objectives that are realistic and achievable, and tailored to local circumstances.
4. Engaging the right improvement team and the relevant stakeholders ensures that plans are informed by people with the right expertise and experience.
5. Frameworks that support and guide improvement efforts – these would help make the best use of limited resources and address the things likely to make the most difference to the quality of the project and its potential impact.

Doing these things well may help to increase the likelihood that small-scale surgical improvement projects will achieve impact and generate learning that can be applied elsewhere.

Our findings align with previous research on large-scale and non-surgical improvement efforts, adding a clear focus on small-scale surgical improvements, an area where detailed knowledge is limited.

Specifically, the study highlights the unique challenges of small-scale improvement initiatives and emphasises the need to assess factors like available effort, engagement, time, capacity, and resources before starting a project.

While our findings are particularly relevant to surgical improvements, they may also apply to other small-scale healthcare initiatives. Future studies will explore this further.