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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).
Background:
Frontline quality improvement (QI) projects are important, but they are not always done well. One reason lies in the weaknesses in the early planning stages, known as the "front-end" of projects. We aimed to develop a framework to guide the very early planning of small-scale, frontline surgical QI efforts.
Study Design:
We used a participatory, iterative design over 5 phases. We first identified content items relevant to QI from existing frameworks. Next, based on this content, sorting exercise was applied to generate thematic categories. A 4-round modified Delphi process involving clinicians and improvement experts was used to prioritize the features of these categories. A 9-step framework diagram and accompanying guidance table were then created. We tested the prototype with frontline clinicians (both attending or consultant surgeons and resident surgeons) using a clinical vignette, comparing the plans prepared by participants with 3 levels of framework exposure: without the framework, with the framework diagram only, and with the framework diagram plus guidance table.
Results:
A framework to guide early planning of small-scale surgical QI projects was developed and tested. It comprised a 9-step diagram and an accompanying table of guidance. Seven planning steps include assembling an improvement team, problem detailing, defining aims, intervention identification, planning implementation and monitoring, and planning end-of-project decisions. Two further steps focus on proceeding and transitioning to launch. Testing with a clinical vignette indicated that using the full framework (framework diagram plus guidance table) may improve project planning by attending or consultant surgeons and resident surgeons.
Conclusions:
The Early Planning of Small-Scale Surgical Improvement framework for surgeons and teams may be valuable in supporting QI. It requires further evaluation to assess its role in improving improvement efforts.
