(Press-News.org) Key Takeaways
An evaluation of 50 surgical QI projects found that only one scored above 70% on criteria for a well-conducted effort, with major deficits in the critical early "front-end" planning stage.
The new EPoSSI framework provides a structured, nine-step guide and checklist to help clinicians systematically plan projects before launch.
In testing, using the full EPoSSI tool (diagram and guidance table) led to an increase in planning comprehensiveness, with participants meeting 100% of scoring criteria compared to just 24% without the framework.
CHICAGO — New study findings show the vast majority of small-scale quality improvement (QI) projects in surgery suffer from poor planning that can doom the effort from the start. To address this challenge, researchers developed and tested a new tool, the Early Planning of Small-Scale Surgical Improvement (EPoSSI) framework, to guide surgeons and their teams through a comprehensive planning process, according to findings published in the Journal of the American College of Surgeons (JACS).
The development of the EPoSSI framework was motivated by a previous evaluation of 50 surgical QI projects, which found that only one met more than 70% of the criteria for a well-conducted effort. A separate review of 242 projects found major deficits in the essential "front-end" planning phase. Earnest healthcare providers undertake scores of QI projects annually to improve patient care, often focusing on efforts to reduce mortality or days in the hospital, for example.
“Many teams enter QI projects with the best intentions, but the evidence shows that, unfortunately, our improvement efforts need improving,” said lead author Clifford Y. Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care. “EPoSSI is designed to provide that critical support for frontline clinicians to get the planning stage right for their quality improvement project and set it up to achieve its goal.”
Key Findings
Significant Planning Gap: When asked to plan a QI project based on a clinical vignette without any guidance, participants' plans met an average of just 6.3 out of 26 criteria (24%).
Major Improvement with EPoSSI: When using the full EPoSSI framework (a nine-step diagram plus a detailed guidance table), participants' plans met all 26 criteria (100%), a statistically significant improvement.
Universal Benefit: The framework was effective for both attending/consultant surgeons and resident surgeons, as well as for individuals working alone or in teams.
The EPoSSI framework was developed through a rigorous, five-phase process that included a literature review of nearly 400 existing frameworks, a sorting exercise with clinicians, and a four-round modified Delphi consensus process involving over 133 frontline clinicians and improvement experts. The final tool consists of nine action-oriented steps: seven for planning, one for a "go/no-go" decision, and one for transitioning to project delivery.
“In sectors like construction, projects with the best front-end planning have 20% lower costs and deliver 10-15% faster,” said Dr. Ko. “If improvement efforts in surgery are to succeed, recognition of the importance of the front-end of QI projects is key. EPoSSI helps teams visualize the process they need to go through in a systematic and low-burden way.”
The Nine Steps of the EPoSSI Framework:
Assemble the improvement team
Detail the problem
Define project aims
Identify an intervention
Plan implementation
Plan in-project monitoring
Plan end-of-project decisions
Make a go/no-go decision
Plan the transition to project delivery
The framework is designed to be agnostic to a specific improvement methodology (e.g., Lean, Six Sigma, Model for Improvement) and functions as a "read-do" checklist to prevent critical omissions in planning. The EPoSSI framework is available for use on the ACS website.
Coauthors are Alessandra Giusti; Graham Martin; and Mary Dixon-Woods, of THIS Institute at the University of Cambridge, United Kingdom.
The study is published as an article in press on the JACS website.
Citation: Development and Testing of a Framework to Support the Planning of Small-scale Improvement Projects in Surgery: A Multi-Stage Process including a Modified Delphi Exercise. Journal of the American College of Surgeons. DOI: 10.1097/XCS.000000000000165
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About the American College of Surgeons
The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.
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