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The implementation of a surgeon-directed quality improvement strategy in breast cancer surgery
Peter Lovrics1, Nicole Hodgson2, Mary Ann O'Brien3
1Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada.
Background:
The investigators designed a sustained, surgeon-directed, iterative project to improve the quality of breast cancer surgery in south central Ontario.
Methods:
The strategy included audit and feedback of surgeon-selected quality indicators, workshops, and tailoring interviews. Workshops were held to discuss quality improvement strategies, select quality indicators, review audited results, and select interventions for subsequent implementation. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All presentations and results were disseminated to all surgeons performing breast surgery in the study region.
Results:
Forty-four surgeons performing breast surgery across 12 hospitals are involved in the project. Five workshops have been held since 2005. Surgeons' enthusiasm and involvement in the project have been positive. Interim results demonstrated that over 4 audit cycles (2006-2010), the preoperative core biopsy rate increased from 73% to 92%. The tailoring interviews indicated that 18 of 21 surgeons performed preoperative core biopsies.
Conclusions:
This project highlights the feasibility of a surgeon-directed, iterative quality improvement strategy in breast cancer surgery. Interim results demonstrate consistent improvements in a key selected quality indicator.
Insights
A surgeon-directed quality improvement project in Ontario demonstrated feasibility and success. The initiative led to a significant increase in preoperative core biopsy rates for breast cancer surgery patients.
Area of Science:
- Surgical Quality Improvement
- Oncology
- Health Services Research
Background:
- A sustained, surgeon-directed, iterative project was developed to enhance breast cancer surgery quality in south central Ontario.
- The project aimed to address variations in surgical care and outcomes through a collaborative approach.
Purpose of the Study:
- To evaluate the feasibility and impact of a surgeon-led quality improvement strategy for breast cancer surgery.
- To identify and implement strategies for improving key quality indicators in breast cancer care.
Main Methods:
- The strategy involved regular audit and feedback of surgeon-selected quality indicators.
- Workshops were conducted for strategy discussion, indicator selection, results review, and intervention planning.
- Semistructured interviews were used to identify facilitators and barriers to quality improvement.
Main Results:
- The project involved 44 surgeons across 12 hospitals, with positive surgeon engagement since 2005.
- Over four audit cycles (2006-2010), the preoperative core biopsy rate increased from 73% to 92%.
- Tailoring interviews revealed that 18 out of 21 surgeons performed preoperative core biopsies.
Conclusions:
- A surgeon-directed, iterative quality improvement strategy is feasible for breast cancer surgery.
- The project demonstrated consistent improvements in a critical, surgeon-selected quality indicator, showcasing the effectiveness of the approach.
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