Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project

Implementation Science

On behalf of the Chole-QuIC collaborator group¹  Nial F. Quiney²  Ian J. Beckingham³  Ellie Duncan⁴  Jonathan R. Bamber⁵  Graham Martin⁶  John F. Abercrombie⁷  Timothy J. Stephens⁸ 

[1] ;Department of Anaesthesia, Royal Surrey County Hospital;Department of Hepatobiliary and Pancreatic Surgery, The Queens Medical Centre;Department of Professional Standards, The Royal College of Surgeons of England;Practicality Consulting;THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge;The Queen’s Medical Centre;William Harvey Research Institute, Queen Mary University of London;

关键词: Quality improvement;    Service improvement;    Breakthrough collaborative;    Gallstone disease;    Evaluation;    Normalisation process theory;   

DOI  :  10.1186/s13012-019-0932-0

来源: DOAJ

【 摘 要 】

Abstract Background Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy. Methods Prospective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams’ ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project. Results Chole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others’ experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway. Conclusion Collaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.

【 授权许可】

Unknown