Quality and Safety Improvement in Surgery

Abstract

Effective surgery quality and safety improvement programs require 5 elements:

• 1. Accurate, risk-adjusted outcomes data with appropriate benchmarks

• 2. Departmental organization conducive to and leadership committed to optimization of outcomes

• 3. Modern tools for quality and safety maintenance

• 4. A just culture

• 5. A systematic approach to quality/safety improvement

Without accurate, risk-adjusted, and benchmarked data, there are no targets for quality improvement. Efforts will focus on single events and often miss significant opportunities for improvement. Departmental structure and leadership must reflect a commitment to continuous improvement. An activist chief surgical quality officer and an empowered Surgical Quality and Safety Committee are key. Robust credentialing and privileging functions, checklists, physician-specific dashboards, pre-induction briefings, post-surgical debriefings, standardized hand-offs, and enforced escalation pathways are among the modern tools required for quality and safety maintenance. Delicately balancing individual and systems accountability through application of just culture and psychological safety principles will create a culture in which significant events and near misses are consistently reported and analyzed. Finally, the identification of quality and safety issues should prompt a systematic response with a well-organized continuous improvement plan, employing the plan, do, check, act (PDCA) or similar methodology.