A methodology for QI in the coronary artery bypass grafting procedure involving comparative process analysis

This report describes an example of applying comparative process analysis to improve surgical procedures. This approach to health care quality improvement relies on combining techniques from the technical disciplines of systems analysis and systems engineering with concepts embodied in the philosophies of total quality management. Coronary artery bypass grafting (CABG) has been examined in a cooperative observational study involving an engineer, cardiac surgeons, perfusionists, nurses, and an anesthesiologist. A baseline process flow for the CABG procedure was developed, against which interinstitutional variations among the five participating medical centers have been identified. On the basis of analysis of the variations, efforts are under way to develop a strategy for incremental continuous improvement in the CABG procedure in each of the five institutions. On the basis of the perceived success of the first phase of the activity, a second phase, wider in scope, has been undertaken.