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Why it matters

High-quality care is often thought of as care that is safe, effective, efficient, patient-centred, timely and equitable. However, achieving high-quality care in surgery is challenging.

A range of quality improvement initiatives has been seen over the last two decades in surgery in the UK and the US, including checklists, briefings and clinical pathways. Despite this, there is still evidence of preventable mortality, complications and inefficiencies.

It is clear that quality improvement itself requires improvement. We have set out three observations about what might help address this.


Observation 1: Data are essential but not sufficient for achieving high quality

Clinical data are needed to support improvement efforts, and surgery lends itself to measurement of processes and outcomes. However, data collection on its own is not enough: there must also be effort directed towards, for example, better processes, equipment modification or replacement, service redesign, and more efficient workflows.

It is important that data are used as the basis of action and are not the sole or most prominent components of improvement efforts.

Observation 2: Improvement efforts need to be conducted well

Poorly conducted improvement efforts waste time, effort, resources and energy, and risk generating scepticism and disengagement among those impacted. Research has found that many quality improvement projects are poorly designed, executed and evaluated. There is often inadequate stakeholder involvement, lack of process evaluation, and insufficient consideration of context, unintended consequences and value.

The resources, skills and expertise required for improvement efforts needs to be recognised and supported.

Observation 3: Small-scale local surgical improvement efforts are common, present a great opportunity to realise better care, and need to be supported

Improvement efforts vary in scale: from large-scale, well-resourced efforts across many organisations; to small-scale, less well-funded efforts, often in a single hospital, department or ward.

These small-scale improvement efforts are important as they are widespread and typically look to address important clinical issues. However, they can be hindered by lack of expertise, skills and knowledge. More tools are needed to support the execution of frontline, small-scale surgical improvement efforts.

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