Surgical Quality Improvement Initiatives May Need Improved Planning

Shah TA, Peters XD, Waddle SD, et al. How Well Are Surgical Quality Improvement Projects Planned? Review of 242 Surgical Improvement Efforts Across Five American College of Surgeons Quality Programs. J Am Coll Surg. 2024, in press.

O’Neill S. The Quest to Make Obligatory Quality Improvement Drive Impactful Change. J Am Coll Surg. 2024, in press.

Shah and coauthors reported characteristics of 242 quality improvement projects conducted in ACS-accredited institutions. All projects were submitted in 2019 and were scored for alignment of problem detailing, goal specification, and strategic planning.

Most projects were conducted in the following ACS Quality Programs: Children’s Surgery Verification Program, Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program, Commission on Cancer, National Accreditation Program for Breast Centers, and the Trauma Verification Program.

The average pre-conduct score was 52%. The highest scores (65%) were in the goal specification category. Possible limiting factors of the proposed project was the least frequently reported component.

The authors concluded that there was a significant opportunity for improvement of project planning and recommended increased use of the ACS Quality Framework.

In the editorial that accompanied the article, O’Neill noted that failure to fulfill the basic criteria for quality improvement (problem identification, intervention application, and outcome reporting) is common with only 15% of projects meeting all three criteria. The editorialist agreed that use of the ACS Quality Framework has potential value but also recommended that creation of a culture of quality in participating institutions rather than a “check the boxes” approach is critical for successful quality improvement.