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Development and Testing of a Framework to Support the Planning of Small-Scale Improvement Projects in Surgery: A

Clifford Y Ko1,2,3, Alessandra Giusti1, Graham Martin1

  • 1From the The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK (Ko, Giusti, Martin, Dixon-Woods).

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Developing a new framework can improve early planning for surgical quality improvement (QI) projects. This structured approach aids surgeons and teams in front-end planning, potentially enhancing project success.

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Area of Science:

  • Healthcare Quality Improvement
  • Surgical Process Management
  • Clinical Project Planning

Background:

  • Frontline quality improvement (QI) projects are crucial but often hampered by inadequate early planning.
  • Weaknesses in the "front-end" planning stages frequently undermine the success of surgical QI initiatives.
  • A need exists for structured guidance in the initial planning phases of small-scale, frontline surgical QI efforts.

Purpose of the Study:

  • To develop a comprehensive framework to guide the very early planning stages of small-scale, frontline surgical quality improvement (QI) projects.
  • To create a structured tool that addresses common weaknesses in the front-end planning of surgical QI initiatives.

Main Methods:

  • A 5-phase participatory, iterative design process was employed.
  • Content from existing QI frameworks was identified, categorized through a sorting exercise, and features were prioritized using a 4-round modified Delphi process with clinicians and experts.
  • A 9-step framework diagram with an accompanying guidance table was developed and tested with surgeons using a clinical vignette.

Main Results:

  • A 9-step framework, "Early Planning of Small-Scale Surgical Improvement," was developed and validated.
  • The framework includes steps for team assembly, problem definition, aim setting, intervention identification, implementation and monitoring planning, and end-of-project decisions, plus launch transition.
  • Testing suggested that utilizing the full framework (diagram and guidance table) may enhance project planning among attending/consultant and resident surgeons.

Conclusions:

  • The "Early Planning of Small-Scale Surgical Improvement" framework offers potential value for surgeons and teams in supporting QI efforts.
  • Further evaluation is necessary to definitively assess the framework's impact on improving the outcomes of surgical QI initiatives.